Early management and physiologic changes in crush syndrome

Potential factors involved in the causation of rhabdomyolysis following status asthmaticus

Rhabdomyolysis is a rare but potentially fatal complication of status asthmaticus. Since the first case was reported in 1978, only a few dozen cases have been described till date. We performed a literature review with the aim to characterize the pathophysiological basis of the occurrence of rhabdomyolysis in patients with status asthmaticus. Excessive exertion of respiratory muscles, hypoxia and acidosis, electrolyte imbalance, infections, some drugs used for asthma control, use of mechanical ventilation, prolonged cardiopulmonary resuscitation, higher age of the patient and some underlying diseases or genetic factors appear to be involved in its causation. In patients with status asthmaticus, it is important to pay more attention to these factors and to closely monitor creatine kinase levels in blood so as to ensure early detection of rhabdomyolysis.

Rhabdomyolysis

Rhabdomyolysis is the dissolution of skeletal muscle. Breakdown of the myocyte causes the extravasation of intracellular constituents, leading to a clinical syndrome--the classic triad of brown urine, muscle pain, and weakness. The pathogenesis of rhabdomyolysis is presented.

Bench-to-bedside review: Rhabdomyolysis -- an overview for clinicians

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.

Elevated plasma nitrate in patients with crush syndrome caused by the Kobe earthquake

We investigated the nitric oxide profile in the plasma of ten healthy controls and 29 patients hurt by the Kobe Earthquake. The levels of nitrite (NO2-) and nitrate (NO3-) were measured simultaneously by high-performance liquid chromatography (HPLC) with UV detection using the Griess reaction after the reduction of nitrate to nitrite. Arginine consumed in food or diet-derived nitrite had no effect on the plasma nitrite and nitrate contents of the healthy volunteers. Plasma nitrate was elevated in the crush syndrome patients; whereas neither nitrite nor nitrate was increased in patients with normal renal function. This finding suggests increased nitric oxide synthesis, decreased excretion of nitric oxide in the crush syndrome or both.

Ecstasy-induced rhabdomyolysis and its role in the development of acute renal failure

Ecstasy (MDMA) is widely used within the dance scene of the 1990s. In this article the growing trend of ecstasy usage among teenagers is considered, in particular, one of its potentially devastating side-effects, rhabdomyolysis. From consideration of the pathophysiology of rhabdomyolysis and its role in the development of acute renal failure, it becomes apparent that preventative measures and prompt treatment can prevent patients developing acute renal failure as a consequence of rhabdomyolysis.

Very long-chain fatty acid pattern in crush syndrome patients in the Kobe earthquake

Profiles of very long-chain fatty acid were studied in the erythrocyte membrane of healthy controls and four patients with crush syndrome caused by the Great-Hanshin Earthquake. The identities of cis-17-hexacosenoic acid (C26:1) and hexacosanoic acid (C26:0) were verified by gas chromatography-mass spectrometry (GC-MS). The ratios C26:1/C22:0, C26:0/C22:0, C24:1/C22:0, and C20:1/C22:0 also were elevated. These findings suggest that active oxygen species and/or free radicals generated by ischemia-reperfusion in the crush syndrome result in beta-oxidation disorders in peroxisomes.

A case of Crush syndrome with giant negative T waves and reversible left ventricular dysfunction

A 54-year-old male experienced the Hanshin earthquake at 5:46 am on Jan. 17, 1995. He was rescued after being buried under his house for 20 h. After being treated at two hospitals, he was admitted to our hospital with acute renal failure caused by crush syndrome. The maximal serum creatinine kinase level was 35,000 IU/L (CK-MM: 100%), and the maximal myoglobin level was 12,600 ng/ml. An electrocardiogram showed inverted T waves in V5,6 which later became giant negative T waves, and a QS pattern in a VL and V1-6. Two-dimensional echocardiography showed a hypokinetic left ventricle. He was treated with hemodialysis 13 times. Cardiac contraction gradually improved to the normal level. Coronary angiography revealed normal coronary arteries and acetylcholine did not induce coronary spasm. Biopsy specimens from the right ventricular septum showed slight degeneration. 201Tl imaging showed hypoperfusion except in the anterior wall and 123I-MIBG imaging showed a perfusion defect except in the anterior wall. After about 1 month, only 201Tl imaging showed improvement. We believe that myocardial ischemia, cardiac sympathetic nerve damage and/or cardiac contusion caused giant negative T waves and left ventricular dysfunction. This is a rare case which showed significant myocardial damage with crush syndrome.