Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice.

Luis O Chavez,Joseph Varon,Sharon Einav,Monica Leon

doi:10.1186/s13054-016-1314-5

Abstract

BackgroundRhabdomyolysis is a clinical syndrome that comprises destruction of skeletal muscle with outflow of intracellular muscle content into the bloodstream. There is a great heterogeneity in the literature regarding definition, epidemiology, and treatment. The aim of this systematic literature review was to summarize the current state of knowledge regarding the epidemiologic data, definition, and management of rhabdomyolysis.MethodsA systematic search was conducted using the keywords “rhabdomyolysis” and “crush syndrome” covering all articles from January 2006 to December 2015 in three databases (MEDLINE, SCOPUS, and ScienceDirect). The search was divided into two steps: first, all articles that included data regarding definition, pathophysiology, and diagnosis were identified, excluding only case reports; then articles of original research with humans that reported epidemiological data (e.g., risk factors, common etiologies, and mortality) or treatment of rhabdomyolysis were identified. Information was summarized and organized based on these topics.ResultsThe search generated 5632 articles. After screening titles and abstracts, 164 articles were retrieved and read: 56 articles met the final inclusion criteria; 23 were reviews (narrative or systematic); 16 were original articles containing epidemiological data; and six contained treatment specifications for patients with rhabdomyolysis.ConclusionMost studies defined rhabdomyolysis based on creatine kinase values five times above the upper limit of normal. Etiologies differ among the adult and pediatric populations and no randomized controlled trials have been done to compare intravenous fluid therapy alone versus intravenous fluid therapy with bicarbonate and/or mannitol.

Highlights

Rhabdomyolysis is a clinical syndrome that comprises destruction of skeletal muscle with outflow of intracellular muscle content into the bloodstream
Rhabdomyolysis is a clinical entity characterized by the destruction of skeletal muscle with resultant release of intracellular enzymatic content into the bloodstream that leads to systemic complications [1, 2]
The term “crush syndrome” is usually used to describe muscle destruction after direct trauma, injury, or compression [7]. It was first described in 1941, when Bywaters and coworkers established a relationship between muscle necrosis and a brown pigment found by autopsy in the renal tubules of patients buried for several hours during a bomb attack in London [8]

Summary

Introduction

Rhabdomyolysis is a clinical syndrome that comprises destruction of skeletal muscle with outflow of intracellular muscle content into the bloodstream. Rhabdomyolysis is a clinical entity characterized by the destruction of skeletal muscle with resultant release of intracellular enzymatic content into the bloodstream that leads to systemic complications [1, 2]. The term “crush syndrome” is usually used to describe muscle destruction after direct trauma, injury, or compression [7]. It was first described in 1941, when Bywaters and coworkers established a relationship between muscle necrosis and a brown pigment found by autopsy in the renal tubules of patients buried for several hours during a bomb attack in London [8]. Manmade and natural disasters comprise the majority of cases of crush syndrome-associated rhabdomyolysis with development of life-threatening complications to this day [7]

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Results