Rhabdomyolysis

Also known as "Crush Syndrome" is a clinical syndrome caused by release of cellular contents after significant injury to striated muscle.[1]

A key feature is large quantities of fluid can be accumulated in inflammed muscle causing significant hypovolemia. So volume replacement is important and can prevent from acute kidney injury.[1]

Released intra-cellular component  special myoglobin is toxic to kidney producing AKI.[1]

Causes:

Trauma(crush injury)

Prolongeed imobility

Compartment syndrome

DSckle cell disease

Drug: Statin,Fibrates,Antimalrials,Zidovudine etc

Toxin:Alcohol,Heroin,Amphetamine etc.

And so many other causes

Clinical Features:

Myalgia

Weaknes

Dark urine upto 50%

 

Investigations:

 

Dipstick test

Urine routine examination

S.electrolytes:Shows hyperglycemia

Creatine kinase: Elevated,Also increased ASL,ALT, LDH

Calcium: Markedly decreased due to sequestration in injured muscle 

Consider:Toxicology screening, Thyroid function if cause is not clear

Management:

 

1.Vigorous fluid resuscitation to attain euvolemia. As much 12L/day may required.

2.Aim urine output more than 150l/hour

3.Urinary alkalization

4.Do not attempt to correct Ca unless symptomatic such as tetany.

5.Dialysis if not improved,severe hyperkalemia

6.Physiotherapy for debilitated patient

Reference:

1) Steddon S, Asman N, Chesser A Cunningham J.Oxford handbook of nephrology and hypertension.Oxford university press.Oxford.2nd edition.pp 152-154