Rhabdomyolysis is a rare critical condition that typically leads to renal failure. Rhabdomyolysis is a condition classified by the rupture of skeletal muscle possibly due to a broad multitude of causes. The causes of rhabdomyolysis ranges from gradual atrophy as result from acute or chronic muscle injuries. This could include any form of muscle trauma, critical burns, prolonged immobility, or abusive misuse, or overuse of the skeletal muscles, which could be a result of induced intoxication or hypothermia, or extreme physical activities. When muscle cells die, various electrolytes along with a substance called myoglobin, a pernicious oxygen storing protein, seeps out of the muscle fibers and is released into the bloodstream. Excess levels of myoglobin will be a disturbance in electrolyte levels and cause further adverse effects on the overall circulatory system function. The excess molecules will eventually clump together and form urinary casts which will be an obstruction in the renal tubules, resulting in the complication of renal failure. (G Efstratiadis, 2007)
Rhabdomyolysis is a rare, yet, life threatening condition affecting less than 200,000 of the 325.7 million population. Though it is not endemic in any specific area, rhabdomyolysis is fairly more common in certain age group. This critical condition is more prevalent in those in their early teens and those in their adulthood as they are more to be susceptible to being victims of muscle overuse. This condition is also found more commonly in those who drug abusers, which is another possible cause of rhabdomyolysis. (Myscal, MD, MS)
Rhabdomyolysis is a condition with a broad set of indications. A rhabdomyolysis patient may notice a dark red or brown color in the urine, which is due to myoglobin secreted into the urine and prompt medical advice. For a diagnosis, the physician will begin by studying the patient’s medical history and physical examination to discover a comprehensive understanding of any possible contributions causing this disease.When this condition is suspected, it can be diagnosed through a blood test for CB, which is performed in a lavender topped-tube with the additive EDTA, comprehensive metabolic panel, performed in a red topped-tube with no additives, and for levels of enzymes, followed by a urinalysis. A blood test with elevated muscle enzymes and elevated electrolytes indicate that muscle has deteriorated and broken down inside of the body. Early on, myoglobin levels will be high, but will soon subside when the kidneys filter it out. Elevated creatine kinase, one of the many enzymes of the body, levels are a major indicator of rhabdomyolysis because it is released during myocyte lysis. The normal CK levels range from 45-260 U/L. However, an individual with rhabdomyolysis may experience CK levels between 10,000-200,000 U/L, but can reach up to 3,000,000,000 U/L. Lactic dehydrogenase, aldolase and transaminases are also usually elevated in this condition. The BUN to creatinine ratio will be another level out of proportion, since there is an increase in creatinine production. The urinalysis of an affected individual should expect increased uric acid around 40 mg/dl. With a rupture of myocytes, there would be a broad spectrum of elevated levels. (Myscal, MD, MS)
Despite the many complications of this critical condition, the treatment of this condition is determined by the severity of the case. There is no concrete method to treating this condition, however, the treatment plan is to alleviate and treat the symptoms of this condition. The treatment is to prevent further advancement It is vital to correct the imbalance of electrolytes and monitor the condition of the kidneys in further advanced cases. If this treatment is promptly initiated, the affected individual should expect no further negative progress. However, if the kidneys have been damaged, it is not a reversible effect that can be done, so severe cases may require chronic dialysis. (G Efstratiadis)
With so many possible causes and adverse effects, there is a wide electrolyte imbalances. From the bedside, the physician can see some indicators of this condition. Early on, the EKG heart rate rhythm will appear normal, but the electrolyte imbalances will have physical changes. Hyperkalemia and hypocalcemia are some of the many common causes of this condition. These specific causes will have evident presentations on an EKG. Hyperkalemia is the medical term for increased levels of the potassium electrolyte. Based on the range of potassium, the physician can recognize the advancement of the effect on the heart, which could be abnormalities with the repolarization of the heart, to accelerative paralysis of the atria, to bradycardia and conduction issues, and possibly even cardiac arrest. In the early stage of hyperkalemia, it will present as simply peaked T waves. (Burns)
As hyperkalemia advances, there will be a less evident P wave along with an expanding and lengthening PR interval in which will eventually be unseen on the EKG . Eventually, the P wave will disappear and there will be a pause in its place, so the rhythm will become bradycardic. (Burns)
In addition to hyperkalemia, hypocalcemia is another electrolyte imbalance possible. Hypocalcemia, like hyperkalemia, has many changes evident on the EKG. In this electrolyte imbalance, the QT interval is prolonged while there is no effect on the T wave. (Burns)