This book describes Rhabdomyolysis, Diagnosis and Treatment and Related Diseases
Rhabdomyolysis is the decomposition (breakdown) of damaged skeletal muscle.
Muscle breakdown causes the discharge of myoglobin into the bloodstream.
Myoglobin is the protein that stocks up oxygen in the muscles.
If a person has too much myoglobin in the blood, it can cause kidney damage.
This would indicate that the kidneys cannot remove waste and concentrated urine.
Infrequently, rhabdomyolysis can even cause death.
1. Trauma or crush injuries
2. Use of drugs such as cocaine, amphetamines, statins, heroin, or PCP
3. Genetic muscle diseases
4. Extremes of body temperature
5. Ischemia or death of muscle tissue
6. Low phosphate levels
1. Muscle weakness,
2. Myalgias, and
3. Dark urine
2. Joint pain
4. Weight gain
A physical examination will reveal tender or injured skeletal muscles.
These tests may be raised:
1. Creatine kinase (CK) level
2. Serum calcium
3. Serum myoglobin
4. Serum potassium
6. Urine myoglobin test
Imaging studies normally play small part in the early diagnosis of rhabdomyolysis.
Radiographs should be obtained when fractures are suspected.
Computed tomography (CT) of the head may be required on a case-by-case basis when a patient with an altered sensorium is assessed.
Patients with significant head trauma may need head CT.
A head CT scan may also be done in patients with first-time seizure activity or extended seizures or in patients with neurological deficits of unknown cause.
Magnetic resonance imaging (MRI) may be helpful in differentiating various causes of myopathy.
One study indicates that bacterial myositis, focal myositis, and idiopathic rhabdomyolysis show a typical gadolinium enhancement on MRI.
1. ECG should be done early in the course of evaluation to assess for cardiac dysrhythmias related to hyper-kalemia or hypo-calcemia.
2. The compartment pressures must be measured in any patient with serious focal muscle tenderness and a firm muscle compartment.
A fasciotomy may be required if compartment pressures in excess of 25-30 mm Hg are evident.
Histology reveals necrotic muscle fibers in patients with rhabdomyolysis.
3. A muscle biopsy may be required to show immunohistochemical features of necrosis only if underlying and often inherited muscle disease is a problem.
4. Immunoblotting, immunofluorescence, and genetic studies may be required to find evidence of inflammatory conditions or dystrophinopathies
1. The doctor should appraise the ABCs (A irway, B reathing, C irculation) and provide supportive care as needed
2. The doctor should ensure adequate hydration, and record urine output.
3. The doctor should identify and correct the inciting cause (e.g., trauma, infection, or toxins)
1. Correction of electrolyte imbalances
2. Institution of measures to prevent of AKI and acute renal failure (ARF) –
a. Urinary alkalization,
c. Loop diuretics
3. Correction of electrolyte, acid-base, and metabolic abnormalities
4. Serial physical examinations and laboratory studies are indicated to monitor for:
a. Compartment syndrome,
c. Acute oliguric or nonoliguric renal failure, and
d. Disseminated intravascular coagulation (DIC).
5. Compartment syndrome needs the immediate orthopedic consultation for fasciotomy.
6. DIC treated with:
a. Fresh frozen plasma,
b. Cryoprecipitate, and
c. Platelet transfusions
Fasciotomy in compartment syndrome
Acute Kidney Injury and acute renal failure:
TABLE OF CONTENT
Chapter 1 Rhabdomyolysis
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Compartment Syndrome
Chapter 8 Crush Injury
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About the Author
Medical doctor since 1972. Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009. Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993. Dr Kenneth Kee is still working as a family doctor at the age of 65. However he has reduced his consultation hours to 3 hours in the morning and 2 hours in the afternoon. He first started writing free blogs on medical conditions seen in the clinic in 2007 on http://kennethkee.blogspot.com. His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog afamilydoctorstale.blogspot.com. This autobiolographical account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Conditions” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com. From which many free articles from the blog was taken and put together into 550 amazon kindle books and some into Smashwords.com eBooks. He apologized for typos and spelling mistakes in his earlier books. He will endeavor to improve the writing in futures. Some people have complained that the simple guides are too simple. For their information they are made simple in order to educate the patients. The later books go into more details of medical conditions. The first chapter of all my ebooks is always taken from my blog A Simple Guide to Medical Conditions which was started in 2007 as a simple educational help to my patients on my first blog http://kennethkee.blogspot.com. The medical condition was described simply and direct to the point. Because the simple guide as taken from the blog was described as too simple, I have increased the other chapters to include more detailed description of the illness, symptoms, diagnosis and treatment. As a result there are the complaints by some readers of constant repetitions of the same contents but in detail and fairly up to date. He has published 550 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter. The purpose of these simple guides is to educate patient on health conditions and not meant as textbooks. He does not do any night duty since 2000 ever since Dr Tan had his second stroke. His clinic is now relocated to the Bouna Vista Community Centre. The 2 units of his original clinic are being demolished to make way for a new Shopping Mall. He is now doing some blogging and internet surfing (bulletin boards since the 1980's) starting with the Apple computer and going to PC. All the PC is upgraded by himself from XT to the present Pentium duo core. The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive. He is also into DIY changing his own toilet cistern and other electric appliance. His hunger for knowledge has not abated and he is a lifelong learner. The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned. This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale. Dr Kee is the author of: "A Family Doctor's Tale" "Life Lessons Learned From The Study And Practice Of Medicine" "Case Notes From A Family Doctor"