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Altaf F, Bhatt V, Venkatram S, Diaz-Fuentes G. Crushing Muscles: A Case Study on Rhabdomyolysis, Renal Failure, and Compartment Syndrome Triggered by Pre-Workout Supplement Abuse. Cureus 2024; 16:e58775. [PMID: 38784349 PMCID: PMC11111323 DOI: 10.7759/cureus.58775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/25/2024] Open
Abstract
The use of steroids and protein-based dietary supplements for muscle enhancement is prevalent in contemporary society. While these products promise increased muscle mass and strength, they carry significant risks, including severe medical complications. The consumption of these supplements has been linked to adverse symptoms, including dehydration, gastrointestinal distress, dizziness, and alterations in heart rate and blood pressure, primarily due to ingredients like creatine, arginine, and caffeine. Following the proper dosage, ensuring adequate hydration, and consulting a healthcare provider to verify if the supplement's components could affect any pre-existing conditions is recommended. Indiscriminate use of these products, including taurine, can lead to serious side effects. We present a 36-year-old patient with severe rhabdomyolysis, life-threatening acid-base imbalance, renal and liver injury, and peripheral neuropathy associated with the use of performance-enhanced unregulated supplements and exercise. This case highlights the importance of recognizing and managing complications related to exercise-aid supplements, emphasizing early identification and management. Increasing social awareness and research on those products is highly needed to avoid supplement-associated complications and potential long-term disabilities.
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Affiliation(s)
- Faryal Altaf
- Internal Medicine, BronxCare Health System, Bronx, USA
| | | | | | - Gilda Diaz-Fuentes
- Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, USA
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Ostrowski P, Bonczar M, Avram AE, Lippi G, Henry BM. Safety monitoring of drug-induced muscle injury and rhabdomyolysis: a biomarker-guided approach for clinical practice and drug trials. Clin Chem Lab Med 2023; 61:1688-1699. [PMID: 37184941 DOI: 10.1515/cclm-2023-0313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/28/2023] [Indexed: 05/16/2023]
Abstract
Skeletal muscle tissue (SKM) may be damaged due to mechanical, metabolic, and exertional causes. However, drug-induced myopathy is among the most frequent causes of muscle disease. The clinical picture of drug-induced myopathies may be highly variable. It may present as asymptomatic or mild myalgias, with or without muscle weakness, which are likely underreported. However, it may also appear as chronic myopathy with severe weakness and, rarely, even as massive rhabdomyolysis with acute kidney injury (AKI). Unfortunately, the available biomarkers for SKM injury do not fully meet the needs for satisfactory detection of drug-induced damage, both in clinical and research settings, mainly due to their low sensitivity and specificity. Therefore, the present study proposes a strategy for drug safety monitoring using the available biomarkers of SKM injury. Moreover, we will discuss mechanisms of drug-induced SKM injury, traditional laboratory testing for SKM injury, and novel skeletal myocyte biomarkers under investigation. This can be incredibly useful in both clinical practice and for de-challenge/re-challenge investigational trials where the risk of drug-induced SKM injury is present.
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Affiliation(s)
- Patryk Ostrowski
- Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Michał Bonczar
- Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | | | - Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University Hospital of Verona, Verona, Italy
| | - Brandon M Henry
- Cmed Research Inc., Morrisville, NC, USA
- Clinical Laboratory, Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
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Luo Y, Liu C, Li D, Yang B, Shi J, Guo X, Fan H, Lv Q. Progress in the Diagnostic and Predictive Evaluation of Crush Syndrome. Diagnostics (Basel) 2023; 13:3034. [PMID: 37835777 PMCID: PMC10572195 DOI: 10.3390/diagnostics13193034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/15/2023] Open
Abstract
Crush syndrome (CS), also known as traumatic rhabdomyolysis, is a syndrome with a wide clinical spectrum; it is caused by external compression, which often occurs in earthquakes, wars, and traffic accidents, especially in large-scale disasters. Crush syndrome is the second leading cause of death after direct trauma in earthquakes. A series of clinical complications caused by crush syndrome, including hyperkalemia, myoglobinuria, and, in particular, acute kidney injury (AKI), is the main cause of death in crush syndrome. The early diagnosis of crush syndrome, the correct evaluation of its severity, and accurate predictions of a poor prognosis can provide personalized suggestions for rescuers to carry out early treatments and reduce mortality. This review summarizes various methods for the diagnostic and predictive evaluation of crush syndrome, including urine dipstick tests for a large number of victims, traditional and emerging biomarkers, imaging-assisted diagnostic methods, and developed evaluation models, with the aim of providing materials for scholars in this research field.
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Affiliation(s)
- Yu Luo
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; (Y.L.)
- Key Laboratory of Medical Rescue Key Technology and Equipment, Ministry of Emergency Management, Wenzhou 325000, China
| | - Chunli Liu
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; (Y.L.)
- Key Laboratory of Medical Rescue Key Technology and Equipment, Ministry of Emergency Management, Wenzhou 325000, China
| | - Duo Li
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; (Y.L.)
- Key Laboratory of Medical Rescue Key Technology and Equipment, Ministry of Emergency Management, Wenzhou 325000, China
| | - Bofan Yang
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; (Y.L.)
- Key Laboratory of Medical Rescue Key Technology and Equipment, Ministry of Emergency Management, Wenzhou 325000, China
| | - Jie Shi
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; (Y.L.)
- Key Laboratory of Medical Rescue Key Technology and Equipment, Ministry of Emergency Management, Wenzhou 325000, China
| | - Xiaoqin Guo
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; (Y.L.)
- Key Laboratory of Medical Rescue Key Technology and Equipment, Ministry of Emergency Management, Wenzhou 325000, China
| | - Haojun Fan
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; (Y.L.)
- Key Laboratory of Medical Rescue Key Technology and Equipment, Ministry of Emergency Management, Wenzhou 325000, China
| | - Qi Lv
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; (Y.L.)
- Key Laboratory of Medical Rescue Key Technology and Equipment, Ministry of Emergency Management, Wenzhou 325000, China
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Martinez T, Liaud-Laval G, Laitselart P, Pissot M, Chrisment A, Ponsin P, Duranteau O, De Rudnicki S, Boutonnet M, Libert N. Study of the Relationship Between Liver Function Markers and Traumatic Rhabdomyolysis: A Retrospective Study of Hemorrhagic Patients Admitted to Intensive Care Unit in a Level I Trauma Center. Anesth Analg 2023; 136:842-851. [PMID: 37058720 DOI: 10.1213/ane.0000000000006406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Traumatic rhabdomyolysis (RM) is common and contributes to the development of medical complications, of which acute renal failure is the best described. Some authors have described an association between elevated aminotransferases and RM, suggesting the possibility of associated liver damage. Our study aims to evaluate the relationship between liver function and RM in hemorrhagic trauma patients. METHODS This is a retrospective observational study conducted in a level 1 trauma center analyzing 272 severely injured patients transfused within 24 hours and admitted to intensive care unit (ICU) from January 2015 to June 2021. Patients with significant direct liver injury (abdominal Abbreviated Injury Score [AIS] >3) were excluded. Clinical and laboratory data were reviewed, and groups were stratified according to the presence of intense RM (creatine kinase [CK] >5000 U/L). Liver failure was defined by a prothrombin time (PT)-ratio <50% and an alanine transferase (ALT) >500 U/L simultaneously. Correlation analysis was performed using Pearson's or Spearman's coefficient depending on the distribution after log transformation to evaluate the association between serum CK and biological markers of hepatic function. Risk factors for the development of liver failure were defined with a stepwise logistic regression analysis of all relevant explanatory factors significantly associated with the bivariate analysis. RESULTS RM (CK >1000 U/L) was highly prevalent in the global cohort (58.1%), and 55 (23.2%) patients presented with intense RM. We found a significant positive correlation between RM biomarkers (CK and myoglobin) and liver biomarkers (aspartate transferase [AST], ALT, and bilirubin). Log-CK was positively correlated with log-AST (r = 0.625, P < .001) and log-ALT (r = 0.507, P < .001) and minimally with log-bilirubin (r = 0.262, P < .001). Intensive care unit stays were longer for intense RM patients (7 [4-18] days vs 4 [2-11] days, P < .001). These patients required increased renal replacement therapy use (4.1% vs 20.0%, P < .001) and transfusion requirements. Liver failure was more common (4.6% vs 18.2%, P < .001) for intense RM patients. It was associated with bivariate and multivariable analysis with intense RM (odds ratio [OR], 4.51 [1.11-19.2]; P = .034), need for renal replacement therapy, and Sepsis-Related Organ Failure Assessment Score (SOFA) score on day 1. CONCLUSIONS Our study established the presence of an association between trauma-related RM and classical hepatic biomarkers. Liver failure was associated with the presence of intense RM in bivariate and multivariable analysis. Traumatic RM could have a role in the development of other system failures, specifically at the hepatic level, in addition to the already known and well-described renal failure.
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Affiliation(s)
- Thibault Martinez
- From the Federation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training Hospital, Clamart, France
| | - Grégoire Liaud-Laval
- From the Federation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training Hospital, Clamart, France
| | - Philippe Laitselart
- From the Federation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training Hospital, Clamart, France
| | - Matthieu Pissot
- From the Federation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training Hospital, Clamart, France
| | - Anne Chrisment
- From the Federation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training Hospital, Clamart, France
| | - Pauline Ponsin
- From the Federation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training Hospital, Clamart, France
| | - Olivier Duranteau
- From the Federation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training Hospital, Clamart, France
| | - Stéphane De Rudnicki
- From the Federation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training Hospital, Clamart, France
| | - Mathieu Boutonnet
- From the Federation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training Hospital, Clamart, France
- École du Val-de-Grâce, French Military Medical Service Academy, Paris, France
| | - Nicolas Libert
- From the Federation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training Hospital, Clamart, France
- École du Val-de-Grâce, French Military Medical Service Academy, Paris, France
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Markedly Elevated Aspartate Aminotransferase from Non-Hepatic Causes. J Clin Med 2022; 12:jcm12010310. [PMID: 36615110 PMCID: PMC9821092 DOI: 10.3390/jcm12010310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
There have been no reports on mortality in patients with markedly elevated aspartate aminotransferase (AST) levels from non-hepatic causes to date. This study aimed to determine the etiologies of markedly elevated AST levels > 400 U/L due to non-hepatic causes and to investigate the factors associated with mortality in these cases. This retrospective study included 430 patients with AST levels > 400 U/L unrelated to liver disease at two centers between January 2010 and December 2021. Patients were classified into three groups according to etiology: skeletal muscle damage, cardiac muscle damage, and hematologic disorder. Binary logistic regression analysis was performed to evaluate the factors associated with 30-day mortality. The most common etiology for markedly elevated AST levels was skeletal muscle damage (54.2%), followed by cardiac muscle damage (39.1%) and hematologic disorder (6.7%). The 30-day mortality rates for the skeletal muscle damage, cardiac muscle damage, and hematologic disorder groups were 14.2%, 19.5%, and 65.5%, respectively. The magnitude of the peak AST level significantly correlated with 30-day mortality, with rates of 12.8%, 26.7%, and 50.0% for peak AST levels < 1000 U/L, <3000 U/L, and ≥3000 U/L, respectively. In the multivariate analysis, cardiac muscle damage (odds ratio [OR] = 2.76, 95% confidence interval [CI] = 1.31−5.80), hematologic disorder (OR = 9.47, 95% CI = 2.95−30.39), peak AST < 3000 U/L (OR = 2.94, 95% CI = 1.36−6.35), and peak AST ≥ 3000 U/L (OR = 9.61, 95% CI = 3.54−26.08) were associated with increased 30-day mortality. Our study revealed three etiologies of markedly elevated AST unrelated to liver disease and showed that etiology and peak AST level significantly affected the survival rate.
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Herrero de la Parte B, Rodrigo I, Gutiérrez-Basoa J, Iturrizaga Correcher S, Mar Medina C, Echevarría-Uraga JJ, Garcia JA, Plazaola F, García-Alonso I. Proposal of New Safety Limits for In Vivo Experiments of Magnetic Hyperthermia Antitumor Therapy. Cancers (Basel) 2022; 14:cancers14133084. [PMID: 35804855 PMCID: PMC9265033 DOI: 10.3390/cancers14133084] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Magnetic hyperthermia is a promising therapy for the treatment of certain types of tumors. However, it is not clear what the maximum limit of the magnetic field to which the organism can be subjected without severe and/or irreversible pathophysiological consequences is. This study aims to study the alterations at the physiological level that may occur after exposure to different combinations of frequency and intensity of the applied alternating magnetic field. Understanding the response to alternating magnetic field exposure will allow us to apply this type of antitumor treatment in a safer way for the patient, while achieving an optimal therapeutic result. Abstract Background: Lately, major advances in crucial aspects of magnetic hyperthermia (MH) therapy have been made (nanoparticle synthesis, biosafety, etc.). However, there is one key point still lacking improvement: the magnetic field-frequency product (H × f = 4.85 × 108 Am−1s−1) proposed by Atkinson–Brezovich as a limit for MH therapies. Herein, we analyze both local and systemic physiological effects of overpassing this limit. Methods: Different combinations of field frequency and intensity exceeding the Atkinson–Brezovich limit (591–920 kHz, and 10.3–18 kA/m) have been applied for 21 min to WAG/RijHsd male rats, randomly distributed to groups of 12 animals; half of them were sacrificed after 12 h, and the others 10 days later. Biochemical serum analyses were performed to assess the general, hepatic, renal and/or pancreatic function. Results: MH raised liver temperature to 42.8 ± 0.4 °C. Although in five of the groups the exposure was relatively well tolerated, in the two of highest frequency (928 kHz) and intensity (18 kA/m), more than 50% of the animals died. A striking elevation in liver and systemic markers was observed after 12 h in the surviving animals, independently of the frequency and intensity used. Ten days later, liver markers were almost recovered in all of the animals. However, in those groups exposed to 591 kHz and 16 kA/m, and 700 kHz and 13.7 kA/m systemic markers remained altered. Conclusions: Exceeding the Atkinson–Brezovich limit up to 9.59 × 109 Am−1s−1 seems to be safe, though further research is needed to understand the impact of intensity and/or frequency on physiological conditions following MH.
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Affiliation(s)
- Borja Herrero de la Parte
- Department of Surgery and Radiology and Physical Medicine, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, ES48940 Leioa, Spain;
- Interventional Radiology Research Group, Biocruces Bizkaia Health Research Institute, ES48903 Barakaldo, Spain; (J.J.E.-U.); (J.A.G.); (F.P.)
- Correspondence: (B.H.d.l.P.); (I.R.)
| | - Irati Rodrigo
- Department of Bioengineering, 340 Hearst Memorial Mining Building, University of California, Berkeley, CA 94720, USA
- Department of Electricity and Electronics, Faculty of Science and Technology, University of the Basque Country UPV/EHU, ES48940 Leioa, Spain
- Correspondence: (B.H.d.l.P.); (I.R.)
| | - Jon Gutiérrez-Basoa
- Department of Gastroenterology and Hepatology, General University Hospital Consortium of Valencia, ES46014 Valencia, Spain;
| | - Sira Iturrizaga Correcher
- Department of Clinical Analyses, Galdakao-Usansolo Hospital, ES48960 Galdakao, Spain; (S.I.C.); (C.M.M.)
| | - Carmen Mar Medina
- Department of Clinical Analyses, Galdakao-Usansolo Hospital, ES48960 Galdakao, Spain; (S.I.C.); (C.M.M.)
| | - Jose Javier Echevarría-Uraga
- Interventional Radiology Research Group, Biocruces Bizkaia Health Research Institute, ES48903 Barakaldo, Spain; (J.J.E.-U.); (J.A.G.); (F.P.)
- Department of Radiology, Galdakao-Usansolo Hospital, ES48960 Galdakao, Spain
| | - Jose Angel Garcia
- Interventional Radiology Research Group, Biocruces Bizkaia Health Research Institute, ES48903 Barakaldo, Spain; (J.J.E.-U.); (J.A.G.); (F.P.)
- Department of Physics, Faculty of Science and Technology, University of The Basque Country UPV/EHU, ES48940 Leioa, Spain
| | - Fernando Plazaola
- Interventional Radiology Research Group, Biocruces Bizkaia Health Research Institute, ES48903 Barakaldo, Spain; (J.J.E.-U.); (J.A.G.); (F.P.)
- Department of Electricity and Electronics, Faculty of Science and Technology, University of the Basque Country UPV/EHU, ES48940 Leioa, Spain
| | - Ignacio García-Alonso
- Department of Surgery and Radiology and Physical Medicine, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, ES48940 Leioa, Spain;
- Interventional Radiology Research Group, Biocruces Bizkaia Health Research Institute, ES48903 Barakaldo, Spain; (J.J.E.-U.); (J.A.G.); (F.P.)
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Kodadek L, Carmichael SP, Seshadri A, Pathak A, Hoth J, Appelbaum R, Michetti CP, Gonzalez RP. Rhabdomyolysis: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document. Trauma Surg Acute Care Open 2022; 7:e000836. [PMID: 35136842 PMCID: PMC8804685 DOI: 10.1136/tsaco-2021-000836] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/16/2021] [Indexed: 12/14/2022] Open
Abstract
Rhabdomyolysis is a clinical condition characterized by destruction of skeletal muscle with release of intracellular contents into the bloodstream. Intracellular contents released include electrolytes, enzymes, and myoglobin, resulting in systemic complications. Muscle necrosis is the common factor for traumatic and non-traumatic rhabdomyolysis. The systemic impact of rhabdomyolysis ranges from asymptomatic elevations in bloodstream muscle enzymes to life-threatening acute kidney injury and electrolyte abnormalities. The purpose of this clinical consensus statement is to review the present-day diagnosis, management, and prognosis of patients who develop rhabdomyolysis.
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Affiliation(s)
- Lisa Kodadek
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Samuel P Carmichael
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Anupamaa Seshadri
- Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abhijit Pathak
- Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jason Hoth
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Rachel Appelbaum
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Richard P Gonzalez
- Department of Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
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Yevtodiyenko A, Bazhin A, Khodakivskyi P, Godinat A, Budin G, Maric T, Pietramaggiori G, Scherer SS, Kunchulia M, Eppeldauer G, Polyakov SV, Francis KP, Bryan JN, Goun EA. Portable bioluminescent platform for in vivo monitoring of biological processes in non-transgenic animals. Nat Commun 2021; 12:2680. [PMID: 33976191 PMCID: PMC8113525 DOI: 10.1038/s41467-021-22892-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/29/2021] [Indexed: 12/29/2022] Open
Abstract
Bioluminescent imaging (BLI) is one of the most powerful and widely used preclinical imaging modalities. However, the current technology relies on the use of transgenic luciferase-expressing cells and animals and therefore can only be applied to a limited number of existing animal models of human disease. Here, we report the development of a “portable bioluminescent” (PBL) technology that overcomes most of the major limitations of traditional BLI. We demonstrate that the PBL method is capable of noninvasive measuring the activity of both extracellular (e.g., dipeptidyl peptidase 4) and intracellular (e.g., cytochrome P450) enzymes in vivo in non-luciferase-expressing mice. Moreover, we successfully utilize PBL technology in dogs and human cadaver, paving the way for the translation of functional BLI to the noninvasive quantification of biological processes in large animals. The PBL methodology can be easily adapted for the noninvasive monitoring of a plethora of diseases across multiple species. Bioluminescence imaging tends to rely on transgenic luciferase-expressing cells and animals. Here the authors report a portable bioluminescent system to non-invasively measure intra- and extracellular enzymes in vivo in non-transgenic animals which do not express luciferase.
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Affiliation(s)
- Aleksey Yevtodiyenko
- Institute of Chemical Sciences and Engineering (ISIC), Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Department of Chemistry, University of Missouri-Columbia, Columbia, MO, USA
| | - Arkadiy Bazhin
- Institute of Chemical Sciences and Engineering (ISIC), Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Pavlo Khodakivskyi
- Institute of Chemical Sciences and Engineering (ISIC), Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Department of Chemistry, University of Missouri-Columbia, Columbia, MO, USA
| | - Aurelien Godinat
- Institute of Chemical Sciences and Engineering (ISIC), Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Ghyslain Budin
- Institute of Chemical Sciences and Engineering (ISIC), Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Tamara Maric
- Institute of Chemical Sciences and Engineering (ISIC), Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Giorgio Pietramaggiori
- Plastic and Reconstructive Surgery, Global Plastic Surgery, Lausanne, Switzerland.,Department of Neurosciences, University of Padova, Padova, Italy
| | - Sandra S Scherer
- Plastic and Reconstructive Surgery, Global Plastic Surgery, Lausanne, Switzerland.,Department of Neurosciences, University of Padova, Padova, Italy
| | - Marina Kunchulia
- Institute of Cognitive Neurosciences, Free University of Tbilisi, Tbilisi, Georgia
| | - George Eppeldauer
- National Institute of Standards and Technology (NIST), Gaithersburg, MD, USA
| | - Sergey V Polyakov
- National Institute of Standards and Technology (NIST), Gaithersburg, MD, USA.,Physics Department, University of Maryland, College Park, MD, USA
| | - Kevin P Francis
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Jeffrey N Bryan
- Department of Veterinary Medicine and Surgery, University of Missouri-Columbia, Columbia, MO, USA
| | - Elena A Goun
- Institute of Chemical Sciences and Engineering (ISIC), Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland. .,Department of Chemistry, University of Missouri-Columbia, Columbia, MO, USA.
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Lim AKH. Abnormal liver function tests associated with severe rhabdomyolysis. World J Gastroenterol 2020; 26:1020-1028. [PMID: 32205993 PMCID: PMC7081005 DOI: 10.3748/wjg.v26.i10.1020] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/06/2020] [Accepted: 03/09/2020] [Indexed: 02/06/2023] Open
Abstract
Rhabdomyolysis is a syndrome of skeletal muscle injury with release of cellular constituents such as potassium, phosphate, urate and intracellular proteins such as myoglobin into the circulation, which may cause complications including acute kidney injury, electrolyte disturbance and cardiac instability. Abnormal liver function tests are frequently observed in cases of severe rhabdomyolysis. Typically, there is an increase in serum aminotransferases, namely aspartate aminotransferase and alanine aminotransferase. This raises the question of liver injury and often triggers a pathway of investigation which may lead to a liver biopsy. However, muscle can also be a source of the increased aminotransferase activity. This review discusses the dilemma of finding abnormal liver function tests in the setting of muscle injury and the potential implications of such an association. It delves into some of the clinical and experimental evidence for correlating muscle injury to raised aminotransferases, and discusses pathophysiological mechanisms such as oxidative stress which may cause actual liver injury. Serum aminotransferases lack tissue specificity to allow clinicians to distinguish primary liver injury from muscle injury. This review also explores potential approaches to improve the accuracy of our diagnostic tools, so that excessive or unnecessary liver investigations can be avoided.
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Affiliation(s)
- Andy KH Lim
- Department of General Medicine, Monash Health, Clayton VIC 3168, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia
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