Treatment Of Rhabdomyolysis Research Articles

Case Report on a Cocktail Drug Abuser Developing Rhabdomyolysis

Rhabdomyolysis is a medical emergency characterized by the break down of skeletal muscle leading to the release of intracellular contents into the blood stream, which can lead to acute kidney injury and even death. Drug abuse is one of the potential causes of rhabdomyolysis. This case report describes a 18-year-old male with a history of drug abuse who presented to the emergency department with severe muscle pain, weakness, dark and reduced amount of urine. The patient was diagnosed with rhabdomyolysis, which was likely due to a combination of high doses Marijuana, Chlorpheniramine, Dextromethorphan (Corex Syrup), Dicyclomine, Tramadol, Acetaminophen and cigarette smoking over period of 4-5 years, landed up in rhabdomyolysis after joining gym. The patient was immediately started on aggressive intravenous fluid resuscitation, and his urine output and electrolyte levels were closely monitored. Patient required initiation of Hemodialysis over period of 15 days. Patient's muscle pain and weakness gradually improved over the next few days, and he was discharged with a diagnosis of AKI due to Rhabdomyolysis due to drug abuse. Prompt recognition and treatment of rhabdomyolysis are crucial to prevent serious complications, and addiction treatment should be pursued to prevent future episodes of rhabdomyolysis and other drugrelated complications.

Penehyclidine Hydrochloride Improves Rhabdomyolysis-Mediated Acute Kidney Injury by Inhibiting Ferroptosis through the HIF-1α/MT1G Axis

Background: Penehyclidine hydrochloride (PHC) has been shown to be effective in the treatment of rhabdomyolysis (RM)-induced acute kidney injury (AKI). Our research sought to investigate the pharmacological effects and mechanisms of PHC on RM-induced AKI. Methods: RM-induced AKI models were established by FeG treatment and glycerol injection. Cell viability was analyzed by cell counting kit-8 assay. Reactive oxygen species (ROS) levels were examined by flow cytometry. The LDH, Fe2+, MPO, MDA, and GSH levels were measured using the corresponding kits. The interaction between HIF-1α and MT1G was analyzed by dual-luciferase reporter gene and chromatin immunoprecipitation assays. The kidney pathological alterations were examined by hematoxylin-eosin staining. The levels of serum creatinine, uric acid, and blood urea nitrogen were examined using ELISA. Ferroptosis-related proteins (SLC7A11, GPX4, and ACSL4) were analyzed by Western blot. Results: PHC administration increased FeG-treated HK-2 cell viability, reduced ROS, LDH, Fe2+, MPO, MDA, and ACSL4 levels, and raised GSH, SLC7A11, and GPX4 levels in cells, suggesting that PHC improved FeG-induced HK-2 cell ferroptosis and injury. PHC protected against AKI primarily by suppressing ferroptosis. HIF-1α blocked the SLC7A11/GPX4 pathway by transcriptionally activating MT1G. PHC alleviated glycerol-induced kidney injury in rats by inhibiting ferroptosis. Conclusion: PHC improved RM-mediated AKI by inhibiting ferroptosis through the HIF-1α/MT1G/SLC7A11/GPX4 axis.

Rhabdomyolysis-Induced AKI (RIAKI) Including the Role of COVID-19

Rhabdomyolysis is a compound disease that may be induced by many factors, both congenital and acquired. Statin therapy is considered one of the most common acquired factors. However, recent scientific reports suggest that serious complications such as rhabdomyolysis are rarely observed. Researchers suggest that, in many cases, side effects that occur with statin therapy, including muscle pain, can be avoided with lower-dose statin therapy or in combination therapy with other drugs. One of the most recent agents discovered to contribute to rhabdomyolysis is COVID-19 disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Rhabdomyolysis is defined as a damage to striated muscle cells with escape of intracellular substances into the bloodstream. These substances, including myoglobin, creatine kinase (CK), potassium, and uridine acid, are markers of muscle damage and early complications of rhabdomyolysis. Symptoms may be helpful in establishing the diagnosis. However, in almost 50% of patients, they do not occur. Therefore, the diagnosis is confirmed by serum CK levels five times higher than the upper limit of normal. One of the late complications of this condition is acute kidney injury (AKI), which is immediately life-threatening and has a high mortality rate among patients. Therefore, the prompt detection and treatment of rhabdomyolysis is important. Markers of muscle damage, such as CK, lactate dehydrogenase (LDH), myoglobin, troponins, and aspartate aminotransferase (AST), are important in diagnosis. Treatment of rhabdomyolysis is mainly based on early, aggressive fluid resuscitation. However, therapeutic interventions, such as urinary alkalinization with sodium bicarbonate or the administration of mannitol or furosemide, have not proven to be beneficial. In some patients who develop AKI in the course of rhabdomyolysis, renal replacement therapy (RRT) is required.

A suspected case of hyponatraemia induced rhabdomyolysis: a case report

BackgroundHyponatraemia is a documented but under-recognised cause of rhabdomyolysis, with the contrasting treatment strategies for the two conditions posing a unique challenge. Balancing the need for aggressive fluid replacement for the treatment of rhabdomyolysis, with the risk of rapidly correcting hyponatraemia is imperative.Case presentationA 52-year-old gentleman with a background of HIV infection and hypertension presented with seizures following methamphetamine use, acute water intoxication, and thiazide use. He was found to have severe hyponatraemia, and following initial correction with hypertonic saline, was commenced on a fluid restriction. After two days he developed abdominal wall and thigh pain, along with oliguria. Laboratory data demonstrated markedly elevated creatine kinase levels and deteriorating renal function. A diagnosis of rhabdomyolysis and severe acute kidney injury was made and aggressive fluid replacement commenced, leading to full resolution of the hyponatraemia, rhabdomyolysis and acute kidney injury.ConclusionHyponatraemia-induced rhabdomyolysis is rare but can cause significant morbidity and mortality if left untreated. Physicians should consider measuring creatine kinase levels in all patients presenting with severe hyponatraemia, particularly in the presence of other risk factors for rhabdomyolysis. Fluid replacement strategies must be considered in relation to the relative onset and risk of over-correcting hyponatraemia.

Application of Ultrasonography in the Diagnosis of Rhabdomyolysis.

Early diagnosis and treatment of rhabdomyolysis are very important, but difficult to achieve for some atypical cases. Our study was aimed at determining the diagnostic value of ultrasonography in rhabdomyolysis caused by different factors. The study enrolled 50 patients with rhabdomyolysis diagnosed in our hospital. Among the 50 cases (mean age=38.4 y, 22 women) of rhabdomyolysis, 26 cases (mean age=35.5 y, 8 women) were induced by exercise. During the patients' first visit, 5 cases (mean age=30.6 y, 1 woman) were suspected of having rhabdomyolysis and were diagnosed by clinicians; 12 cases (mean age=34.8 y, 5 women) were correctly diagnosed under ultrasound; and 9 cases (mean age=39.2 y, 2 women) were misdiagnosed. Ultrasound did not play a critical role in 24 patients (mean age=41.5 y, 14 women) with rhabdomyolysis caused by trauma, infection, crayfish consumption, drugs, alcohol and heat stroke. We then concluded that exercise-induced rhabdomyolysis is a common type of rhabdomyolysis. Ultrasonography plays an important role in the early diagnosis of exercise-induced rhabdomyolysis but has limited value in the diagnosis of rhabdomyolysis caused by other etiologies.

Beneficial effects of dantrolene in the treatment of rhabdomyolysis as a potential late complication associated with COVID-19: a case report

BackgroundPatients with severe COVID-19 have disorders of the respiratory, cardiovascular, coagulation, skeletal muscle, and central nervous systems. These systemic failures may be associated with cytokine release syndrome, characterized by hyperpyrexia, thrombocytopenia, hyperferritinemia, and the elevation of other inflammatory markers. Rhabdomyolysis with high fever is a complication that is rarely found in COVID-19. The exact relations of these clinical conditions in patients with COVID-19 remain unknown.Case presentationWe present the case of a 36-year-old man with severe COVID-19 complicated by rhabdomyolysis and high fever. After admission, his condition continued to deteriorate, with a high body temperature. On day 9, the patient had elevated creatine kinase and myoglobin levels consistent with rhabdomyolysis (26,046 U/L and 3668 ng/mL, respectively). In addition to viral therapy, he was immediately treated with hydration. However, the patient had persistent fever and elevated creatine kinase levels. The patient was diagnosed with malignant hyperthermia as a late complication of COVID-19, although he had no hereditary predisposition to malignant hyperthermia or neuroleptic malignant syndrome. The administration of dantrolene with muscle relaxation and anti-inflammatory function showed potential efficacy for rhabdomyolysis, high fever, and increased plasma inflammatory markers.ConclusionsMalignant hyperthermia is triggered by not only anesthetic agents but also viral infections. A possible mechanism of malignant hyperthermia is hypersensitivity of calcium release from the sarcoplasmic reticulum. These include mutations in or the activation of the skeletal muscle ryanodine receptor calcium release channel. Dantrolene is a ryanodine receptor antagonist and is used as an anti-inflammatory agent. The administration of dantrolene showed potential efficacy for rhabdomyolysis, high body temperature due to inflammation, and increased inflammatory markers. The underlying mechanism of the association of rhabdomyolysis and high fever in COVID-19 might be similar to the pathogenesis of malignant hyperthermia.

Bicarbonate May Not Be the Best Treatment for Rhabdomyolysis: A Retrospective Cohort Study

Bicarbonate May Not Be the Best Treatment for Rhabdomyolysis: A Retrospective Cohort Study

A Case of Non–occlusive Mesenteric Ischemia Complicated by Treatment for Rhabdomyolysis

A Case of Non–occlusive Mesenteric Ischemia Complicated by Treatment for Rhabdomyolysis

Causes, Clinical Features and Treatment of Rhabdomyolysis: A Retrospective Analysis

Background: RM is a condition of skeletal muscle breakdown which ranges from an asymptomatic illness with elevation in CK level to a life-threatening condition associated with extreme elevation in CK, electrolyte imbalance, AKI, and disseminated intravascular coagulation. In this study, the author analyzed the causes, clinical features, and treatments of RM. Methods: The study collected the records of 48 patients in the First Affiliated Hospital of Jinan University who were diagnosed RM from June 2012 to August 2016. By using SPSS to analyse the data, the study draw a clear chart about the distribution of patients’ age, etiologies and clinical symptoms respectively. The statistic analysis also reveals dramatically change on CK and other indicators after treatment. Results: A total of 48 patients were eligible for the study (mean age = 29.7 ± 12.3 years; 36 males and 12 females). Strenuous exercises and infections took the greatest percent amount the causes of RM. Muscular weakness and muscle aches were the two most common symptoms. Among the patients, 42 received intravenous (IV) fluid therapy, and none developed acute kidney injury (AKI). The other six patients accepted CRRT, five of whom had an alleviation of their symptoms. One patient was transferred to another hospital for further treatment since the primary disease was dermatomyositis and it was non-responsive to immunotherapy. Discussion and conclusions: RM is treatable if early diagnosis, comprehensive therapy, active prevention, and the timely elimination of complications are put into effect. Its main symptoms such as muscle aches, muscular weakness, and dark urine may not presented at the same time. In this study, Strenuous exercise is the most common cause of RM and IV fluid therapy is the cornerstone of RM treatment. CRRT should also be considered when life-threatening electrolyte abnormalities emerge as complications of AKI, or when the RM is non-responsive to initial therapy.

The Analysis of the Treatment of Rhabdomyolysis by Snake Bites

Objective: To explore the treatment measure of rhabdomyolysis caused by snake bites, and provide guidance for further prevention and control of snake bites. Methods: To retrospectively analyze the 841 cases of serpentine bites in our hospital from January 2006 to July 2017; 127 cases of patients with rhabdomyolysis syndrome were screened out, and their clinical manifestations, laboratory results, related treatment and prognosis were analyzed. Results: 127 cases patients were rhabdomyolysis out of 841 cases, 28 cases patients developed acute renal failure; treatment measures included local wound treatment, application of tetanus antitoxin, anti-snake venom serum, anti-infection, fluid “hydration” and diuretic, alkaline urine and hybrid renal replacement therapy. 112 cases were cured, improved conditions in 9 cases, 3 cases of death, 3 cases uncured. The improvement rate of is 95.26% after treatment. Conclusion: The rhabdomyolysis had a high incidence in snake bite patients, severe cases often developed acute renal failure. Serum myopsin and related biochemical blood tests could be used to diagnose rhabdomyolysis quickly. Combined treatment methods are the main measure to increase the cured rate and decrease the death rate.

Continuous Veno-Venous Hemofiltration for the Treatment of Rhabdomyolysis Induced Acute Kidney Injury

Continuous Veno-Venous Hemofiltration for the Treatment of Rhabdomyolysis Induced Acute Kidney Injury

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

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.

Nontraumatic rhabdomyolysis with short‐term alcohol intoxication – a case report

Key Clinical MessageAlcohol-induced rhabdomyolysis is a potentially life-threatening condition due to the probability of progression to acute renal injury. Patients admitted to emergency department with acute alcohol intoxication should always undergo blood and urine tests for early recognition and treatment of rhabdomyolysis.

Treatment of 2, 4-Dichlorophenoxyacetic Acid (2, 4-D) Poisoning; a Case Study

Background: 2, 4-Dichlorophenoxyacetic Acid (2, 4-D) is an herbicide in chlorophenoxy group that use as a weed killer. Acute poisoning with 2, 4-D may be fatal in large ingestion. There is no specific antidote for 2, 4-D herbicide poisoning. We report here a case of 2, 4-D toxicity with rhabdomyolysis.Case Report: In this case study we present a case of intentional consumption of 2, 4-D herbicide with main gastrointestinal complain that became toward rhabdomyolysis and liver damage during hospital course. Successful treatment with sodium bicarbonate and other conservative therapies was performed.Conclusion: In cases of 2, 4-dichlorophenoxyacetic acid poisoning, rhabdomyolysis should be in mind and an alkaline diuresis can increase herbicide elimination as well as treatment of rhabdomyolysis should be considered.

Prevention of Kidney Injury Following Rhabdomyolysis: A Systematic Review

To conduct a systematic literature review to evaluate evidence-based recommendations for the prevention of rhabdomyolysis-associated acute renal failure (ARF). PubMed (1966-December 2012), International Pharmaceutical Abstracts, Science Citation Index, and Cochrane databases (1970-December 2012) were searched. There were no language restrictions. Studies selected dealt with treatment of rhabdomyolysis (crush syndrome) or prevention of ARF in patients with rhabdomyolysis. Articles excluded did not present original data or described only the management of ARF after it developed. Single case reports were excluded. Extracted data included study type; population; definitions of rhabdomyolysis and ARF; fluid, sodium bicarbonate, and mannitol dosages; and study findings. Twenty-seven studies met the inclusion criteria. No controlled trials compared intravenous fluid administration plus sodium bicarbonate to fluid administration alone. Three concluded that there was no significant difference in the rates of ARF between patients receiving and those not receiving sodium bicarbonate; however, urine alkalinization was not documented. Eight investigations concluded that delayed fluid administration increased the risk of ARF. No controlled study compared volumes of fluid administered or targeted urine output goals. Fluid type, therapy duration, and monitoring parameters varied widely; 4 used a urine output goal in adults of more than 300 mL/h or 300 mL/h or more. No evidence supported a preferred fluid type or that sodium bicarbonate with or without mannitol was superior to fluid therapy alone. Intravenous fluids should be initiated as soon as possible, preferably within the first 6 hours after muscle injury, at a rate that maintains a urine output in adults of 300 mL/h or more for at least the first 24 hours. Sodium bicarbonate should be administered only if necessary to correct systemic acidosis and mannitol only to maintain urine output of 300 mL/h or more despite adequate fluid administration.

A 10-year-old boy with dark urine and acute kidney injury: answer

Keywords Rhabdomyolysis.Acute kidney injury.Carnitine palmitoyltransferase II deficiencyAbbreviationsAKI acute kidney injuryacyl-CoAs acylcoenzyme A derivativesCPT II carnitine palmitoyltransferase II deficiencyFAO fatty acid β-oxidationAnswers1. Severe rhabdomyolysis related to a mild form ofcarnitine palmitoyltransferase II (CPT II) deficiency.Diagnosis was suspected clinically by the occurrence ofsevere and recurrent rhabdomyolysis and based on theacylcarnitine profile. The diagnosis was confirmed bythe measurement of CPT II enzyme activity andsubsequent molecular analysis.2. First, the patient had a genetic disorder of lipidmetabolism, namely, a mild form of CPT II deficiency,which was responsible for the severe rhabdomyolysis,which in turn can be triggered by fever, exercise, andcold. Furthermore, viral myositis is a common cause ofrhabdomyolysis in children [1], and rapid testing forInfluenza A was positive in our patient. Influenzainfection-related severe rhabdomyolysis has alreadybeen reported [2]. Life-threatening rhabdomyolysismay be a consequence of any Influenza infection inpatients with CPT II deficiency [3].3. The primary cause of acute kidney injury (AKI) inthis patient is the rhabdomyolysis. Rhabdomylolysismay not be the only cause of AKI. Indeed, ourpatient also presented with diarrhea and occasionalvomiting and was probably dehydrated. Finally, acumulative dose of 60 mg/kg body weight ofibuprofen was given as self-medication 1 day priorto admission. All of these elements may havecontributed to a deterioration of the renal functiondue to hypoperfusion and/or vasoconstriction.4. The management regimen includes the treatment ofrhabdomyolysis-induced AKI and the prevention offurther rhabdomyolysis episodes.Supportive treatment of rhabdomyolysis consists of theearly and aggressive repletion of fluids. Alkalinization of

Rhabdomyolysis associated with mania in late life

We report a case of rhabdomyolysis associated with acute mania in a 74 year old man. What makes this case noteworthy is the development of multiple episodes of rhabdomyolysis in the context of excessive physical exercise in an old man who was never diagnosed with a psychiatric illness. Rhabdomyolysis is a potentially fatal condition that follows skeletal muscle injury and can lead to serious complications such as renal failure (1) (2). Skeletal muscle injury, traumatic or non-traumatic, may trigger the release of intracellular contents including creatine phosphokinase (CPK) and myogobin which is manifested by elevated serum CPK and myoglobinuria (1) (2). The classic triad of rhabdomyolysis is muscle pain, weakness and dark urine (1) (2). In a study of 77 patients aged 21–85 years who developed rhabdomyolysis, 8 patients of unspecified age died (3). Delay in diagnosis and treatment of rhabdomyolysis may increase the risk of mortality (1) (2) therefore, early identification and intervention are crucial for a good outcome. The prevalence of rhabdomyolysis is unknown and considered rare, however, descriptions are confined mostly to case reports (1) (2). The incidence of rhabdomyolysis in psychiatric patients is not known (1). Nevertheless, several risk factors make psychiatric patients more vulnerable to develop rhabdomyolysis and these factors include catatonia, agitation, alcohol abuse, and neuroleptic medications (1) (2) (4) (5).

Exertional Compartment Syndrome of the Thigh: A Rare Diagnosis and Literature Review

Exercise-induced acute compartment syndrome of the thigh is an uncommon entity. We present a rare case of bilateral exercise-induced three-compartment syndrome of the thighs that required fasciotomies. The objective of this study was to understand the history, physical examination, signs, symptoms, pathophysiology, diagnosis, and treatment of compartment syndrome and rhabdomyolysis. A 42-year-old man presented to the Emergency Department (ED) complaining of worsening pain and swelling in both thighs 45 h after performing a lower extremity exercise regimen. The patient's thighs were tender and swollen, but there was no ecchymosis or evidence of trauma. Admitting serum creatinine kinase (CK) was 106,289 U/L. Treatment for rhabdomyolysis was initiated. The next day, he complained of escalating bilateral thigh pain. Repeat serum CK was 346,580 U/L. The patient was diagnosed with bilateral thigh compartment syndrome and immediately taken to the operating room for fasciotomies. Postoperatively, the patient's symptoms improved rapidly and his serum CK quickly returned to normal. His incisions were closed and he returned to normal activities of daily living. Because exercise-induced compartment syndrome is an extremely rare diagnosis with a high risk of poor outcome, this article serves to emphasize the importance of considering this diagnosis during the work-up of patients presenting to the ED with rhabdomyolysis.

Rhabdomyolysis

Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle causing myoglobin and other intracellular proteins and electrolytes to leak into the circulation. The development of rhabdomyolysis is associated with a wide variety of diseases, injuries, medications and toxins. While the exact mechanisms responsible for all the causes are not fully understood, it is clear that muscle damage can occur from direct injury or by metabolic inequalities between energy consumption and energy production. Rhabdomyolysis is diagnosed by elevations in serum creatine phosphokinase (CPK), and while there is no established serum level cut-off, many clinicians use five times the upper limit of normal ( approximately 1000 U/l). Rhabdomyolysis can be complicated by acute renal failure (occurring in 4%-33% of patients), compartment syndrome, cardiac dysrhythmias via electrolyte abnormalities, and disseminated intravascular coagulopathy. The mainstay of treatment is hospitalisation with aggressive intravenous fluid (IVF) resuscitation with the correction/prevention of electrolyte abnormalities. There are additional adjunctive therapies to IVF, such as alkalinisation of the urine with sodium bicarbonate, diuretic therapy or combinations of both; however the lack of large randomised control studies concerning the benefits of these treatments makes it difficult to make strong recommendations for or against their use in the treatment of rhabdomyolysis. Regardless of these controversies, the overall prognosis for rhabdomyolysis is favourable when treated with early and aggressive IVF resuscitation, and full recovery of renal function is common. Irrespective of the cause of rhabdomyolysis the mortality rate may still be as high as 8%. This is a comprehensive review of the pathophysiology, diagnosis, complications and treatment options for rhabdomyolysis.

Rhabdomyolysis: Diagnosis and Treatment in Bariatric Surgery

Rhabdomyolysis (RML) and subsequent acute renal failure can be serious problems following bariatric operations. Early diagnosis and treatment are important to avoid the complications of RML. This review was achieved by searching the key words: Rhabdomyolysis, diagnosis, treatment and bariatric surgery. We included prospective, retrospective, case reports and review articles. RML diagnosis can be done by: signs and symptoms, physical evaluation, laboratory findings and imaging examinations. Muscle weakness, myalgia, decubitus ulcer, proteinuria and myoglobinuria are the more mentioned findings. Elevation of CPK levels is the most sensitive diagnostic evidence of RML. Treatment is geared toward preserving renal function by avoiding dehydration, hypovolemia, tubular obstruction, aciduria, and free radical release. Early recognition allows the administration of fluids, bicarbonate, and mannitol. Prophylactic measures and early diagnosis and treatment of rhabdomyolysis in bariatric surgery are imperative to prevent the potential fatal complications of this condition.