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Anyabolu EN, Okoye IC, Chukwuonye II, Anyabolu AE, Dike KC, Ufoaroh CU. Minor Blunt Injury-induced Rhabdomyolysis from a Road Traffic Accident in Nigeria. Niger Med J 2020; 61:102-105. [PMID: 32675903 PMCID: PMC7357808 DOI: 10.4103/nmj.nmj_114_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/04/2019] [Accepted: 02/27/2020] [Indexed: 11/04/2022] Open
Abstract
Rhabdomyolysis, though not a common complication of minor blunt trauma, may result in life-threatening acute kidney injury (AKI). Here is illustrated a case of a young male who sustained minor blunt injuries in a road traffic accident, which he overlooked and presented with features of severe AKI. The patient is a 24-year-old male, who presented with progressive weakness, difficulty in walking, and features of uremia, 14 days after he sustained minor blunt injuries and lacerations in a road traffic accident. Evaluation showed elevated serum creatine kinase, serum myoglobin, and severe azotemia. He was commenced on hemodialysis. He was also commenced on antibiotics, analgesic, and 5% dextrose/saline. He had three sessions of hemodialysis on alternate days. His condition improved remarkably after the first session of dialysis. He was discharged after 18 days on admission. Follow-up in the clinic showed a normal renal function. This case report shows rhabdomyolysis from minor blunt injuries sustained in a road traffic accident and complicated by severe AKI. The patient almost recovered full renal function with management.
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Kolovou G, Cokkinos P, Bilianou H, Kolovou V, Katsiki N, Mavrogeni S. Non-traumatic and non-drug-induced rhabdomyolysis. Arch Med Sci Atheroscler Dis 2019; 4:e252-e263. [PMID: 32368681 PMCID: PMC7191942 DOI: 10.5114/amsad.2019.90152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/10/2019] [Indexed: 01/19/2023] Open
Abstract
Rhabdomyolysis (RM), a fortunately rare disease of the striated muscle cells, is a complication of non-traumatic (congenital (glycogen storage disease, discrete mitochondrial myopathies and various muscular dystrophies) or acquired (alcoholic myopathy, systemic diseases, arterial occlusion, viral illness or bacterial sepsis)) and traumatic conditions. Additionally, RM can occur in some individuals under specific circumstances such as toxic substance use and illicit drug abuse. Lipid-lowering drugs in particular are capable of causing RM. This comprehensive review will focus on non-traumatic and non-drug-induced RM. Moreover, the pathology of RM, its clinical manifestation and biochemical effects, and finally its management will be discussed.
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Affiliation(s)
- Genovefa Kolovou
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Philip Cokkinos
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Vana Kolovou
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
- Molecular Immunology Laboratory, Onassis Cardiac Surgery Center, Athens, Greece
| | - Niki Katsiki
- First Department of Internal Medicine, Division of Endocrinology-Metabolism, Diabetes Center, AHEPA University Hospital, Thessaloniki, Greece
| | - Sophie Mavrogeni
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
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Mamidi V, E. I, Shekar M, Elumalai R, Makkena VK, Chakola JJ, Bandi VK, Joy N, Matcha J. Pigment Nephropathy in a Patient With PYGM Gene Mutation. Kidney Int Rep 2019; 4:740-744. [PMID: 31080931 PMCID: PMC6506694 DOI: 10.1016/j.ekir.2019.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Varun Mamidi
- Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Indumathi E.
- Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
- Correspondence: E. Indumathi, Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India 600116.
| | - Manikantan Shekar
- Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Ramprasad Elumalai
- Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Vamsi Krishna Makkena
- Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Jaiju James Chakola
- Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Varun Kumar Bandi
- Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Niranjana Joy
- Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Jayakumar Matcha
- Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Sabha MM, Simo HT, Shadid RM, Altorok NI. Successful treatment of antisynthetase syndrome presenting as rhabdomyolysis with rituximab. Rheumatol Int 2018; 38:1125-1130. [PMID: 29644434 DOI: 10.1007/s00296-018-4025-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/03/2018] [Indexed: 01/04/2023]
Abstract
Rhabdomyolysis is a syndrome of muscle necrosis with subsequent release of intracellular content into the blood. There are various causes for rhabdomyolysis that include trauma, medications and rarely autoimmune conditions such as autoimmune myositis. Antisynthetase syndrome is an autoimmune condition characterized by positive antisynthetase antibody, myopathy, lung disease and arthritis. To our knowledge, rhabdomyolysis in antisynthetase syndrome has not been reported in the literature. In this report, we present a patient who presented with features of rhabdomyolysis and was diagnosed with antisynthetase syndrome. This patient was treated with systemic steroids with partial improvement, followed by rituximab, which led to significant improvement in his condition. In addition, we summarize all cases reported in the literature of inflammatory myopathy-associated rhabdomyolysis.
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Affiliation(s)
- Marwa Mohammed Sabha
- Department of internal medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Hermann Talom Simo
- Department of internal medicine, University of Toledo Medical Center, Toledo, OH, USA
| | | | - Nezam Ibrahim Altorok
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH, 43614, USA.
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Kim J, Lee J, Kim S, Ryu HY, Cha KS, Sung DJ. Exercise-induced rhabdomyolysis mechanisms and prevention: A literature review. JOURNAL OF SPORT AND HEALTH SCIENCE 2016; 5:324-333. [PMID: 30356493 PMCID: PMC6188610 DOI: 10.1016/j.jshs.2015.01.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 10/26/2014] [Accepted: 01/26/2015] [Indexed: 05/27/2023]
Abstract
Exercise-induced rhabdomyolysis (exRML), a pathophysiological condition of skeletal muscle cell damage that may cause acute renal failure and in some cases death. Increased Ca2+ level in cells along with functional degradation of cell signaling system and cell matrix have been suggested as the major pathological mechanisms associated with exRML. The onset of exRML may be exhibited in athletes as well as in general population. Previous studies have reported that possible causes of exRML were associated with excessive eccentric contractions in high temperature, abnormal electrolytes balance, and nutritional deficiencies possible genetic defects. However, the underlying mechanisms of exRML have not been clearly established among health professionals or sports medicine personnel. Therefore, we reviewed the possible mechanisms and correlated prevention of exRML, while providing useful and practical information for the athlete and general exercising population.
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Affiliation(s)
- Jooyoung Kim
- Health and Rehabilitation Major, College of Physical Education, Kookmin University, Seoul 136-702, Republic of Korea
| | - Joohyung Lee
- Health and Rehabilitation Major, College of Physical Education, Kookmin University, Seoul 136-702, Republic of Korea
| | - Sojung Kim
- Department of Physical Education, Global Campus, Kyung Hee University, Suwon 446-701, Republic of Korea
| | - Ho Young Ryu
- Division of Sport Science, College of Science and Technology, Konkuk University, Choong-Ju 380-702, Republic of Korea
| | - Kwang Suk Cha
- Division of Sport Science, College of Science and Technology, Konkuk University, Choong-Ju 380-702, Republic of Korea
| | - Dong Jun Sung
- Division of Sport Science, College of Science and Technology, Konkuk University, Choong-Ju 380-702, Republic of Korea
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7
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Boutaud O, Roberts LJ. Mechanism-based therapeutic approaches to rhabdomyolysis-induced renal failure. Free Radic Biol Med 2011; 51:1062-7. [PMID: 21034813 PMCID: PMC3116013 DOI: 10.1016/j.freeradbiomed.2010.10.704] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 10/18/2010] [Accepted: 10/19/2010] [Indexed: 10/18/2022]
Abstract
Rhabdomyolysis-induced renal failure represents up to 15% of all cases of acute renal failure. Many studies over the past 4 decades have demonstrated that accumulation of myoglobin in the kidney is central in the mechanism leading to kidney injury. However, some discussion exists regarding the mechanism mediating this oxidant injury. Although the free-iron-catalyzed Fenton reaction has been proposed to explain the tissue injury, more recent evidence strongly suggests that the main cause of oxidant injury is myoglobin redox cycling and generation of oxidized lipids. These molecules can propagate tissue injury and cause renal vasoconstriction, two of the three main conditions associated with acute renal failure. This review presents the evidence supporting the two mechanisms of oxidative injury, describes the central role of myoglobin redox cycling in the pathology of renal failure associated with rhabdomyolysis, and discusses the value of therapeutic interventions aiming at inhibiting myoglobin redox cycling for the treatment of rhabdomyolysis-induced renal failure.
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Affiliation(s)
- Olivier Boutaud
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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8
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Abstract
AIM Influenza B-associated rhabdomyolysis (IBAR) is an infrequent and little-known complication of influenza B virus infection in children. Diagnosis is usually made based on clinical history, the presence of influenza in the community and detection of virus in nasopharyngeal specimens. The aim of this study was to describe the clinical and laboratory manifestations, complications and outcomes of IBAR in Taiwanese children. METHODS A retrospective analysis was conducted in patients aged < 17 years who had been diagnosed with IBAR at a university children's hospital in North Taiwan during 2000-2007. All children enrolled in the study had presented with rhabdomyolysis associated with laboratory-confirmed influenza B infections. Demographic data, clinical manifestations, complications and outcomes were included in the analysis. RESULTS Overall, 24 IBAR cases were analysed. IBAR typically occurred in school-aged children with a 7:3 male:female ratio. The mean age was 7.2 ± 1.9 years. Nearly 63% of cases occurred between the ages of 6 and 9 years. The median interval between the onset of influenza and onset of IBAR was 3.4 days (range, 1-14). The calf muscles were involved in all cases. Laboratory tests indicated a mean initial blood creatine kinase of 4212 U/L. The median time to clinical recovery was 5 days (range 1-24). No patient had renal failure. IBAR tends to occur mainly in winter and spring during influenza B outbreaks. IBAR sometimes induces some complications, and early detection and careful medical treatment are necessary. CONCLUSION The results of this study indicate that outcomes of IBAR are good with proper medical care.
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Affiliation(s)
- C-T Wu
- Division of Pediatric Emergency Medicine, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tauyuan, Taiwan.
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9
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Kumagai H, Matsumoto S, Nozu K. Hypokalemic rhabdomyolysis in a child with Gitelman's syndrome. Pediatr Nephrol 2010; 25:953-5. [PMID: 20072789 DOI: 10.1007/s00467-009-1412-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 11/17/2009] [Accepted: 11/24/2009] [Indexed: 12/27/2022]
Abstract
We report here the first published case of a pediatric patient with Gitelman's syndrome (GS) in whom hypokalemia-associated rhabdomyolysis developed. A 13-year-old girl was admitted with weakness of the extremities, walking difficulty and calf pain. Laboratory data showed a serum potassium level of 2.1 mmol/l and a serum creatinine phosphokinase level of 1,248 IU/l plus myoglobinemia. The presence of normomagnesemia was the basis for a genetic analysis of the thiazide-sensitive sodium chloride cotransporter gene, which revealed compound heterozygous mutations in this gene. Prompt fluid expansion and potassium supplementation led to regression of the muscle symptoms. Hypokalemia can be a rare cause of rhabdomyolysis in patients with GS, even in childhood. We emphasize that genetic analysis is advisable to determine whether the suspicion of GS is warranted.
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Affiliation(s)
- Hideki Kumagai
- Department of Pediatrics, Hitachiomiya Saiseikai Hospital, Hitachiomiya, Ibaraki, Japan.
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10
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Karagüzel G, Bahat E, Imamoğlu M, Ahmetoğlu A, Yildiz K, Okten A. An unusual case of an aldosterone-producing adrenocortical adenoma presenting with rhabdomyolysis. J Pediatr Endocrinol Metab 2009; 22:1087-90. [PMID: 20101896 DOI: 10.1515/jpem.2009.22.11.1087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Rhabdomyolysis is a rare presentation of hypokalemia, although muscle weakness is a well known manifestation of marked hypokalemia. Here, we report a case of primary hyperaldosteronism due to unilateral aldosterone-producing adenoma in a 14 year-old girl who developed rhabdomyolysis following hypokalemia. To our knowledge, this is the first case of adrenocortical adenoma presenting with rhabdomyolysis in a child.
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Affiliation(s)
- Gülay Karagüzel
- Division of Pediatric Endocrinology, Department of Pediatrics, School of Medicine, Karadeniz Technical University, Trabzon, Turkey.
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11
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Eliason JL, Wakefield TW. Metabolic consequences of acute limb ischemia and their clinical implications. Semin Vasc Surg 2009; 22:29-33. [PMID: 19298933 DOI: 10.1053/j.semvascsurg.2009.01.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Acute limb ischemia is a common medical condition resulting from arterial embolization, in situ thrombosis, trauma, and other causes. The severity of injury is related to the duration of ischemia and the effects of reperfusion. Metabolic consequences of reperfusion injury can be variable, ranging from transient symptoms in the lower extremity to systemic inflammation with multiple organ dysfunction. This article provides an overview of some of the key mediators of reperfusion injury. Additional discussion is focused on the clinical effects of reperfusion in the extremity, as well as the pulmonary, cardiac, and renal organ systems. A better understanding of these processes may result in improved patient outcomes and decreased mortality.
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Affiliation(s)
- Jonathan L Eliason
- Section of Vascular Surgery, University of Michigan Health System, Ann Arbor, MI 48109-5867, USA.
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12
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Yilmaz S, Demircioğlu F, Oren H, Güneş B, Irken G. Rhabdomyolysis due to Escherichia coli sepsis in three pediatric patients with acute lymphoblastic leukemia. Pediatr Hematol Oncol 2009; 26:57-62. [PMID: 19322735 DOI: 10.1080/08880010802434990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Rhabdomyolysis with myoglobinuria is an uncommon complication of bacterial sepsis. The authors describe three pediatric acute lymphoblastic leukemia patients who developed rhabdomyolysis during a neutropenic sepsis episode due to Escherichia coli. All of the patients needed hemodynamic supportive treatment because of septic shock. Broad-spectrum antibiotics, alkalinization, and intravenous fluid therapy was given. One patient with renal insufficiency died, despite aggressive treatment. Muscle pain and dark urine color should alert physicians to the possibility of rhabdomyolysis in immunocompromised patients with sepsis. Early and appropriate treatment is critical in these patients to prevent renal failure and shock, and for a better outcome.
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Affiliation(s)
- Sebnem Yilmaz
- Department of Pediatric Hematology, Dokuz Eylül University, 35340 Balcova, Izmir, Turkey.
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13
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Abstract
Rhabdomyolysis is the disintegration of striated muscles resulting in the release of muscular cell contents into the extracellular fluid. Crush syndrome is systemic manifestations caused by rhabdomyolysis; the most important component of crush syndrome is acute kidney injury. Non-physical and physical causes play a role in the aetiology of rhabdomyolysis. Clinical spectrum varies from asymptomatic elevation in creatine kinase to acute tubular necrosis and multiorgan failure. Myoglobinuria, increased serum creatine kinase level and hyperkalaemia are the most important laboratory parameters. Vigorous hydration with isotonic saline followed by alkaline solutions and mannitol are useful in the treatment of rhabdomyolysis.
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Affiliation(s)
- M S Sever
- Istanbul Tip Fakultesi, Ic Hastaliklari Anabilim Dali, Nefroloji Bilim Dali, Istanbu, Turkey.
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14
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Atabek ME, Pirgon O, Sert A. Hypokalemic rhabdomyolysis in a child with 11-hydroxylase deficiency. J Pediatr Endocrinol Metab 2008; 21:93-6. [PMID: 18404978 DOI: 10.1515/jpem.2008.21.1.93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Myopathy is a well-recognized complication of persistent hypokalemia. Although hypokalemic myopathy may be due to divers diseases or to drug administration, hypokalemic rhabdomyolysis as a complication of under-treated 11-hydroxylase deficiency has not previously been described in the literature. We describe a 10-year-old boy with under-treated 11-hydroxylase deficiency who developed rhabdomyolysis following severe hypokalemia. Patients with under-treated 11-hydroxylase deficiency may present with hypokalemia in association with muscle weakness; if serum potassium is markedly low, rhabdomyolysis may occur. Hypokalemia-induced rhabdomyolysis should be carefully followed.
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Affiliation(s)
- Mehmet Emre Atabek
- Department of Pediatric Endocrinology, Faculty of Medicine, Selcuk University, Turkey
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15
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Abstract
An 8-year-old child who was physically abused and developed rhabdomyolysis is presented. A literature review revealed 13 previously reported cases of child physical abuse and rhabdomyolysis. Including the patient in this report, 13 of 14 children had extensive soft tissue muscle injuries to the buttock or legs. Nine patients developed acute renal failure, but none required renal dialysis treatment. A simple urine dipstick test can be used to screen children at risk for rhabdomyolysis. The importance of early recognition and treatment is made clear by a review of the pathophysiology of rhabdomyolysis.
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Affiliation(s)
- Joyce Peebles
- Pediatric Department, Medical University of South Carolina, Children's Hospital, Charleston, SC, USA
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16
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Pela I, Materassi M, Seracini D, Lavoratti G, Bettinelli A. Hypokalemic rhabdomyolysis in a child with Bartter's syndrome. Pediatr Nephrol 2005; 20:1189-91. [PMID: 15942789 DOI: 10.1007/s00467-005-1916-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 02/08/2005] [Accepted: 02/15/2005] [Indexed: 12/01/2022]
Abstract
Hypokalemia represents a rare cause of rhabdomyolysis. Some reports have described a few adult patients affected by Bartter's syndrome and Gitelman's syndrome with rhabdomyolysis due to severe hypokalemia. We report the first pediatric patient with Bartter's syndrome in whom rhabdomyolysis developed when her plasma potassium level was less than 2 mEq/l. Prompt intravenous fluid and potassium prevented tubular damage and acute renal failure. We recommend determining serum creatine phosphokinase in all patients affected by Bartter's syndrome and profound hypokalemia.
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Affiliation(s)
- Ivana Pela
- Pediatric Nephrology, Department of Pediatrics, University of Florence, Firenze, Italy.
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Huerta-Alardín AL, Varon J, Marik PE. Bench-to-bedside review: Rhabdomyolysis -- an overview for clinicians. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2004; 9:158-69. [PMID: 15774072 PMCID: PMC1175909 DOI: 10.1186/cc2978] [Citation(s) in RCA: 518] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rhabdomyolysis ranges from an asymptomatic illness with elevation in the creatine kinase level to a life-threatening condition associated with extreme elevations in creatine kinase, electrolyte imbalances, acute renal failure and disseminated intravascular coagulation. Muscular trauma is the most common cause of rhabdomyolysis. Less common causes include muscle enzyme deficiencies, electrolyte abnormalities, infectious causes, drugs, toxins and endocrinopathies. Weakness, myalgia and tea-colored urine are the main clinical manifestations. The most sensitive laboratory finding of muscle injury is an elevated plasma creatine kinase level. The management of patients with rhabdomyolysis includes early vigorous hydration.
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Affiliation(s)
| | - Joseph Varon
- The University of Texas Health Science Center and St Luke's Episcopal Hospital, Houston, Texas, USA
| | - Paul E Marik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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18
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Abstract
Rhabdomyolysis is a disorder characterized by acute damage of the sarcolemma of the skeletal muscle leading to release of potentially toxic muscle cell components into the circulation, most notably creatine phosphokinase (CK) and myoglobin, and is frequently accompanied by myoglobinuria. Therefore, the term myoglobinuria is often used interchangeably with the term rhabdomyolysis. This disorder may result in potential life-threatening complications such as acute myoglobinuric renal failure, hyperkalemia and cardiac arrest, disseminated intravascular coagulation, and compartment syndrome. The condition is etiologically heterogeneous and may result from a large variety of diseases affecting muscle membranes, membrane ion channels, and muscle energy supply including acquired causes (e.g., exertion, crush injury and trauma, alcoholism, drugs, and toxins) and hereditary causes (e.g., disorders of carbohydrate metabolism, disorders of lipid metabolism, or diseases of the muscle associated with malignant hyperthermia). In many patients with idiopathic recurrent rhabdomyolysis, specific inherited metabolic defects have not been recognized up to now.
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Affiliation(s)
- A Lindner
- Neurologische Klinik, Marienhospital Stuttgart.
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19
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Shende D, Agarwal R. Anaesthetic management of a patient with Emery-Dreifuss muscular dystrophy. Anaesth Intensive Care 2002; 30:372-5. [PMID: 12075650 DOI: 10.1177/0310057x0203000320] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Emery-Dreifuss muscular dystrophy is a rare form of muscular dystrophy associated with cardiac implications such as cardiomyopathy and arrhythmias leading to sudden death. We describe the anesthetic management of a patient with Emery-Dreifuss muscular dystrophy who presented for orthopaedic surgery and discuss the disorder and its potential anaesthetic implications.
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Affiliation(s)
- D Shende
- Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi
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20
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Abstract
Rhabdomyolysis, a syndrome of skeletal muscle breakdown with leakage of muscle contents, is frequently accompanied by myoglobinuria, and if sufficiently severe, acute renal failure with potentially life-threatening metabolic derangements may ensue. A diverse spectrum of inherited and acquired disorders affecting muscle membranes, membrane ion channels, and muscle energy supply causes rhabdomyolysis. Common final pathophysiological mechanisms among these causes of rhabdomyolysis include an uncontrolled rise in free intracellular calcium and activation of calcium-dependent proteases, which lead to destruction of myofibrils and lysosomal digestion of muscle fiber contents. Recent advances in molecular genetics and muscle enzyme histochemistry may enable a specific metabolic diagnosis in many patients with idiopathic recurrent rhabdomyolysis.
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Affiliation(s)
- Jason D Warren
- Department of Neurology, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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21
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Vanholder R, Sever MS, Erek E, Lameire N. Acute renal failure related to the crush syndrome: towards an era of seismo-nephrology? Nephrol Dial Transplant 2000; 15:1517-21. [PMID: 11007816 DOI: 10.1093/ndt/15.10.1517] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Vanholder
- Renal Division, University Hospital, Gent, Renal Disaster Relief Task
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22
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Abstract
Although rhabdomyolysis is an uncommon disorder, especially in children, it can present as a severe, life-threatening event. Paediatricians need to be aware of this important, probably underdiagnosed disorder in order to implement appropriate early treatment. In this report, seven children with rhabdomyolysis of both forms, endogenous and exogenous, are presented. Despite comprehensive 'up-to-date' investigations being performed on paediatric patients with endogenous (often recurrent) rhabdomyolysis, the majority of these patients' underlying disorders will remain undiagnosed. Overall, these patients usually have a very good prognosis even if repeated, severe life-threatening episodes occur. It is recommended that a regimen of early therapy with fluids and sodium bicarbonate be instituted in all patients with rhabdomyolysis.
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Affiliation(s)
- Y T Ng
- Department of Neurology, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia.
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Affiliation(s)
- Raymond Vanholder
- Renal Division, University Hospital, Gent, Belgium (Renal Disaster Relief Task Force of the International Society of Nephrology)
| | - Mehmet Sükrü Sever
- Istanbul Medical Faculty, Çapa Campus, Istanbul, Turkey (local coordinator for the Renal Disaster Relief Task Force)
| | - Ekrem Erek
- Istanbul Medical Faculty, Cerrahpasha Campus, Istanbul, Turkey (President of the Turkish Society of Nephrology)
| | - Norbert Lameire
- Renal Division, University Hospital, Gent, Belgium (coordinator for the European Section of the Renal Disaster Relief Task Force)
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Bruno C, Bado M, Minetti C, Cordone G, DiMauro S. Novel mutation in the CPT II gene in a child with periodic febrile myalgia and myoglobinuria. J Child Neurol 2000; 15:390-3. [PMID: 10868782 DOI: 10.1177/088307380001500607] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We have identified a novel missense mutation in the carnitine palmitoyltransferase II (CPT II) gene in a child with CPT II deficiency characterized clinically by episodes of myalgia and myoglobinuria induced by intercurrent febrile illnesses. The patient was heterozygous for a G-to-A substitution at codon 487, changing an encoded glutamic acid to a lysine (E489K), while the other allele carried the common S113L mutation. This case enlarges the spectrum of mutations in patients with CPT II deficiency, and confirms the association of the S113L mutation with the muscular form.
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Affiliation(s)
- C Bruno
- Department of Pediatrics, University of Genova, Istituto Giannina Gaslini, Italy
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Cuisset JM, Cuvellier JC, De Sèze C, Lombes A, Matran R, Fontaine M, Vallée L. [Diagnostic approach to metabolic myopathies]. Arch Pediatr 2000; 7 Suppl 2:120s-121s. [PMID: 10904679 DOI: 10.1016/s0929-693x(00)80006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J M Cuisset
- Service des maladies infectieuses et neurologie infantiles, hôpital Roger-Salengro, CHRU, Lille, France
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Abstract
Rhabdomyolysis is a relatively common condition that may occur intermittently in chronic and inflammatory myopathy, muscular dystrophy, and metabolic myopathy. Rhabdomyolysis can also present acutely in otherwise healthy individuals. The list of etiologies for acute muscle cell lysis is enormous, with new causes described yearly. Series on acute pediatric rhabdomyolysis have not yet been published. This article describes a retrospective review of children admitted to the authors' institution during an 8-year period in whom rhabdomyolysis was recognized as a complication during their hospital stay. Patients with intermittent or relapsing rhabdomyolysis were excluded. Nineteen children were identified. Trauma (five cases), nonketotic hyperosmolar coma (two cases), viral myositis (two cases), dystonia (two cases), and malignant hyperthermia-related conditions (two cases) were the most common causes of rhabdomyolysis. Acute renal failure was the most frequent complication, occurring in 42% of cases. The mean age of renal failure patients was 13.9 years, compared to 8 years for non-renal failure children. Careful assessment of the initial urinalysis would have suggested a diagnosis of rhabdomyolysis in 9 of 16 patients tested.
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Affiliation(s)
- N Watemberg
- Child Neurology Division, Medical College of Virginia, Richmond, USA.
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Abstract
An asymptomatic 13-year-old boy, who never complained of exercise intolerance or myalgia, was found to have markedly elevated serum creatine kinase (CK) levels during a routine check-up. General physical and neurologic examinations were normal. Surprisingly, histochemical and biochemical analysis of muscle showed myophosphorylase deficiency and genetic analysis showed that the patient was homozygous for the most common mutation encountered in McArdle's disease (R49X). This case illustrates the fuzzy correlation between molecular defect and clinical phenotype in patients with McArdle's disease, and suggests that a thorough study of the muscle biopsy is important in patients with idiopathic hyperCKemia for correct diagnosis and careful follow-up.
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Affiliation(s)
- C Bruno
- Department of Neurology, Columbia University, New York, NY, USA
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Abstract
Rhabdomyolysis results from muscular fibre lysis with release of cellular contents (myoglobin, enzymes, electrolytes) into the plasma. Traumatic (crush syndrome) and non-traumatic rhabdomyolysis have been mostly reported in adults. Traumatic rhabdomyolysis are mostly due to ischemic and reperfusion injuries. Non-traumatic rhabdomyolysis include several factors: muscular compression (comas), cytotoxic injury (infections and poisonings), ischemia (shock, cardiorespiratory arrest) or excessive muscular activity (seizures, strenuous exercise). The main etiologies reported in children are: anoxic-ischemic encephalopathy (including sudden infant death and life threatening events); electrolyte disorders; severe hyperthermia; poisonings; hereditary myopathies. Non-traumatic rhabdomyolysis must be suspected in these circumstances, requiring blood creatinine phosphokinase measurements. Indeed, clinical signs are inconstant and non-specific, and functional signs are difficult to appreciate in children. During the initial phase, the main risk is arrhythmias secondary to hyperkalemia. The two main complications are the compartmental syndrome leading to irreversible vasculo-nervous injuries and acute renal failure. Treatment of traumatic and non-traumatic rhabdomyolysis includes correction of hyperkalemia, active fluid loading in order to prevent acute renal failure and alkalinisation. Prognosis of rhabdomyolysis relates to the aetiology and the presence of acute renal failure.
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Affiliation(s)
- V Hue
- Service de réanimation pédiatrique, hôpital Jeanne-de-Flandre, CHRU, Lille, France
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Affiliation(s)
- C Bruno
- Muscle Diseases Service, University of Genova, Gaslini Children's Hospital, Italy
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Pedrozzi NE, Ramelli GP, Tomasetti R, Nobile-Buetti L, Bianchetti MG. Rhabdomyolysis and anesthesia: a report of two cases and review of the literature. Pediatr Neurol 1996; 15:254-7. [PMID: 8916167 DOI: 10.1016/s0887-8994(96)00171-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Rhabdomyolysis occurred in two apparently healthy boys aged 9.5 and 5.5 years after general anesthesia with suxamethonium. Mild hyperkalemia and renal failure were observed in the first patient, who was subsequently diagnosed with Becker dystrophy. In the second patient, the clinical presentation was not classic for malignant hyperthermia and a muscle biopsy failed to disclose any pathological finding. A review of the literature revealed 66 pediatric cases (56 boys and 10 girls) of anesthesia-associated rhabdomyolysis. Forty-nine (74%) cases were caused by an underlying, mostly unrecognized congenital muscle disease, and 14 (21%) cases were caused by malignant hyperthermia susceptibility. Hyperkalemia (23 patients), cardiac arrhythmias (38 patients), renal failure (4 patients), and death (11 patients) were the most serious complications of anesthesia-associated rhabdomyolysis. The neuromuscular blocking agent suxamethonium had been used in at least 43 of the patients reported in the literature.
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Affiliation(s)
- N E Pedrozzi
- Department of Pediatrics, Ospedale San Giovanni, Bellinzona, Switzerland
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Jensen V. The anaesthetic management of a patient with Emery-Dreifuss muscular dystrophy. Can J Anaesth 1996; 43:968-71. [PMID: 8874917 DOI: 10.1007/bf03011813] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE This case report presents a patient with Emery-Dreifuss Muscular Dystrophy and describes the anaesthetic considerations. CLINICAL FEATURES The features of Emery-Dreifuss Muscular Dystrophy are contractures, humeroperoneal muscle weakness and cardiomyopathy. The anaesthetic considerations for this syndrome are difficult tracheal intubation, difficult spinal anaesthetic, heart block, gastric reflux, rhabdomyolysis, and unproved malignant hyperthermia susceptibility. CONCLUSION The major anaesthetic problem for the patient with Emery-Dreifuss Muscular Dystrophy could be a life-threatening cardiomyopathy.
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Affiliation(s)
- V Jensen
- Department of Anaesthesia, Walter Mackenzie Centre, University of Alberta Hospitals, Edmonton
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De Kerviler E, Leroy-Willig A, Duboc D, Eymard B, Syrota A. MR quantification of muscle fatty replacement in McArdle's disease. Magn Reson Imaging 1996; 14:1137-41. [PMID: 9065903 DOI: 10.1016/s0730-725x(96)00236-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
McArdle's disease is an energy-dependent disorder of skeletal muscle caused by the inability to break down glycogen. The aim of this study was to quantify fatty replacement in patients with McArdle's disease. Calf and thigh axial spin echo T1-weighted magnetic resonance (MR) images (repetition time 500 ms, echo time 25 ms) were obtained at 0.5 T in nine patients with McArdle's disease (age 51 +/- 16 years, range 26-74) and nine sex- and age-matched healthy subjects (age 52 +/- 16 years, range 29-78) to quantify intramuscular fat. Regions of interest were drawn manually, encompassing the largest cross section of muscle. A fatty replacement index (IF) was determined from histograms of signal in the regions of interest in calf and thigh muscles. In normal subjects, IF = 3.6 +/- 2.8% in calf and 4.9 +/- 2.3% in thigh. In patients, IF = 11 +/- 9.3% in calf and 13.5 +/- 10.4% in thigh, significantly different from IF values in normal subjects (p = .03). IF correlated well with age in patients (p = .03). In older patients, up to 25% of the muscle volume was replaced by fat. Patients with McArdle's disease, usually weakly disabled, exhibit significant muscle fatty replacement on MR images. These findings suggest a progressive muscle loss over time related to the disease process.
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Affiliation(s)
- E De Kerviler
- Service de Radiologie, Hôpital Saint-Louis, Paris, France
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Sato T, Ota M, Matsuo M, Tasaki H, Miyazaki S. Recurrent reversible rhabdomyolysis associated with hyperthermia and status epilepticus. Acta Paediatr 1995; 84:1083-5. [PMID: 8652966 DOI: 10.1111/j.1651-2227.1995.tb13832.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A 6-year-old boy developed rhabdomyolysis following hyperthermia and status epilepticus with a diagnosis of severe myoclonic epilepsy of infancy. At 2 and 3 years of age, he had similar episodes. Each time he recovered completely in 3-4 weeks with conservative management, in spite of renal insufficiency and marked liver dysfunction. Several cases of recurrent myoglobinuria after intense exercise of generalized tonic-clonic convulsions were reported to have genetic errors of carbohydrate or lipid metabolism of muscle. In our patient, however, the activity of these enzymes was found to be normal. This indicates that status epilepticus may cause recurrent rhabdomyolysis in subjects with normal glycolytic and lipolytic enzyme activity.
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Affiliation(s)
- T Sato
- Department of Pediatrics, Saga Medical School, Japan
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