Renal - Rhabdomyolysis Flashcards
What is rhabdomyolysis?
Apoptosis of skeletal muscle releasing breakdown products into the blood
What is released from rhabdomyolysis?
Myoglobin
Potassium
Phosphate
Creatine Kinase
Why is rhabdomyolysis so dangerous?
Potassium release which can lead to hyperkalaemia causing cardiac arrhythmias and arrest
Why does rhabdomyolysis cause AKI?
Myoglobin toxic in high concentrations
Impaired renal function can also cause accumulation of the substances in the blood
What are some less common complications of rhabdomyolysis?
Compartment syndrome
Disseminated intravascular coagulation
What are some causes of rhabdomyolysis?
Prolonged immobility
Extremely rigorous exercise (endurance events)
Crush injuries
Seizures
Statins
What are the signs of rhabdomyolysis?
Oliguria
Myoglobinuria
Confusion
What are the symptoms of rhabdomyolysis?
Muscle pain
Muscle weakness
Muscle swelling
Fatigue
Nausea and vomiting
What investigations are used for rhabdomyolysis?
Creatine Kinase
Normally less than 150 U/L
Rises in first 12 hours, remains elevated for 1-3 days then gradually falls
High CK means higher risk of AKI
Myoglobinuria
Myoglobin in the urine
Urine dipstick positive for blood
Urea and electrolytes
Required for AKi and hyperkalaemia
ECGs
Assess hyperkalaemia
How is rhabdomyolysis managed?
IV fluids to correct hypovolaemia and encourage filtration of breakdown products
Treatment of complications
- IV sodium bicarbonate (increase urinary pH and reduce toxic effects of myoglobinuria)
- IV mannitol (increase urine output and reduce oedema)
