Rhabdomyolysis (Crush syndrome) - Medtick

Rhabdomyolysis (Crush syndrome)

What is it?

When skeletal muscle tissues are damaged or die, their components/releasing substances enter the blood stream to be filtered and are then broken and removed from the body.

  • Several of these components for example the protein pigment myoglobin (myoglobin is the protein that stores oxygen in your muscles) can lead to kidney damage and/or kidney failure if released in excessive amounts or if one kidney does not function properly initially.
  • Complication of this condition can depend on the severity of the case and on several individual factors i.e.
  • Minor cases may not cause any noticeable symptoms and might only be spotted with blood serum tests.

  • Myoglobin can block the complex tubing system of the kidney. If blockages become severe enough, kidney damage and failure can occur.
  • Other cellular enzymes, especially creatine kinase (CK), also put stress on the kidney.
  • Damaged muscle tissues also retain body fluids.
    • This can cause dehydration as well as reduce the flow of blood to the kidney, thereby increasing the risk of organ damage.
  • The complications associated with rhabdomyolysis depend on the severity of the case and on several individual factors. Minor cases may not cause any noticeable symptoms and might only be spotted with blood serum tests.

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If one experience severe muscle pain from the causes listed below, this can be life-threatening.

Diagnosis Tests

  • To make a diagnosis, laboratory confirmation is normally required. This tends to involve detection of elevated CK (CK is an enzyme called creatine kinase (CK) in your blood. CK is a type of protein.
  • The muscle cells in your body need CK to function.
  • Levels of CK can rise after a heart attack, skeletal muscle injury, or strenuous exercise levels)  in the blood and the presence of myoglobin in the urine.
  • In many instances, muscle biopsies are also carried out to confirm and assess muscle damage.

CK levels

  • The upper limit of normal levels are considered to be evidence of rhabdomyolysis. The definition of normal CK levels in the blood varies by sex, race, and ethnicity.
  • Activity or physical exertion may raise CK levels temporarily. As a result, tests should be done after avoiding rigorous activity for roughly 7 days.
  • Genetic testing may also be performed in people with suspected cases of rhabdomyolysis, in order to check for the presence of inherited muscle conditions.

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Cause

Syndromes

Illicit drugs

Medication

  • Statins (cholesterol)
  • Anti-psychotics medication (which can cause severe muscle rigidity with rhabdomyolysis and high fever)
  • Ephedrine (found in decongestants)
  • Caffeine containing products (i.e. painkillers)
  • Neuromuscular blocking agents used in anaesthesia may result in malignant hyperthermia, also associated with rhabdomyolysis
  • Medications that cause serotonin syndrome i.e. SSRIs
  • Medications that interfere with potassium levels, such as diuretics
  • Cyclosporin
  • Erythromycin
  • Colchicine (gout)

Vitamins, herbals and minerals

Symptoms

(Most symptoms first appear within hours to days after the condition develops or a cause has occurred)

Common early symptoms of rhabdomyolysis include:

  • Muscle pain, often extremely painful aching and throbbing?
  • Aching, painful muscles, muscle cramps/spasms/stiffness?
  • Muscle swelling or inflammation?
  • General discomfort (muscle weakness), uneasiness or ill feeling (malaise) and/or fatigue (tiredness)?
  • Balance and Dizziness?
  • Confusion and/or disoriented and/or light-headed, or feeling faint?
  • High temperature greater than 38°C (100°F) or over and/or chills and sweats?
  • Bleeding under the skin and/or bruising of unknown cause?
  • Dark and/or cola-coloured and/or tea-coloured urine (presence of myoglobin) ?
  • Low urine output and/or no urination for over eight hours?
  • Overactive (urgency to go to toilet) or underactive bladder and/or difficult to start urinating and stop urinating (Strain to urinate due to weak flow)?
  • Irregular heartbeat?
  • Nausea or vomiting?
  • Abdominal pain and/or are constant violently vomiting or vomiting longer than two days (one day if a child)?

Complications /Information to beware of/General tips:

This condition can lead to:

  • Dehydration
  • Lack of urination (12-24 hours after muscle damage)
  • Kidney failure
  • High blood potassium
  • Low blood calcium
  • Disseminated intravascular coagulation (a severe disruption in blood clotting that may lead to uncontrollable bleeding)
  • Compartment syndrome (painful and potentially serious condition caused by bleeding or swelling within an enclosed bundle of muscles)
  • Low blood pressure especially after muscle injury
  • Shock especially after muscle injury:
    • Rapid heart rate (rapid pulse)
    • Rapid breathing
    • Dilated pupils
    • Pale, cool skin
    • Sweating (diaphoresis)
    • Yawning
  • If shock occurs (whilst awaiting for an ambulance):
    • Lay the person down (if their injuries allow it) and raise and support their legs
    • Use a coat or blanket to keep them warm, but do not cover their face or the burnt area
    • Do not give them anything to eat or drink

Prevention

  • The easiest way to prevent rhabdomyolysis is to avoid prolonged periods of immobilization, stay hydrated, and exercise within healthy limits.
  • If you have an existing degenerative muscle condition or have sustained damage to your muscle after a recent trauma, you can prevent rhabdomyolysis by staying well-hydrated at all times.
  • Carry a full refillable water bottle with you at all times so you can make sure you’ll have access to something to drink.
  • Drink whenever you begin to feel thirsty. Don’t wait until your thirst increases.

Other common tips to help prevent the condition include:

  • Drinking plenty of fluids before and after strenuous exercise. This will dilute your urine and help your kidneys eliminate any myoglobin that your muscles may have released during exercise.
  • Avoiding weight – loss, muscle gain, or performance-enhancing dietary supplements, especially those containing creatine, ephedrine, ephedra, or high levels of caffeine
  • Listening to one’s body when exercising and not going beyond what feels comfortable or natural to do
  • Seeking training advice if attempting a major physical event (such as running a marathon)
  • Increasing workout intensity and frequency slowly
  • Treating conditions or complications that are considered to be risk factors

Seek immediate medical attention as soon as symptoms occur or if the condition is suspected

Detailed Information

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