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| Rhabdomyolysis: Taking it one day at a time | |
| --Jonathan
A. Handler, M.D. |
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| Question-A-Day
for Monday: What are the most common causes of
rhabdomyolysis? Answer: Alcohol, drugs, infections, trauma and seizures are the leading causes of rhabdomyolysis. |
| Question-A-Day
for Tuesday: How frequently are the classic complaints of
myalgia (muscle pain) or muscle weakness seen in rhabdomyolysis? Answer: These symptoms are unreliable. In one study, only 50% of patients with proven rhabdomyolysis had these complaints. |
| Question-A-Day
for Wednesday: How frequently do patients with rhabdomyolysis
present with the classic examination of the disorder:
muscle weakness, tenderness, and swelling with discoloration of
overlying skin? Answer: These signs are present less than 20% of the time (seen 4% to 15% of the time). |
| Question-A-Day
for Thursday: How sensitive is a urine dipstick for blood
in detecting rhabdomyolysis? Answer: The urine "dip" for blood is not only non-specific, it appears to lack adequate sensitivity for diagnosis of this disorder. In one large study, about 1/4 of the patients with serologically proven rhabdomyolysis had negative "dips" for blood. |
| Question-A-Day
for Friday: What is the most commonly encountered electrolyte
abnormality in rhabdomyolysis? Answer: Hypocalcemia (low calcium) is the most commonly encountered electrolyte abnormality in this condition. It occurs very early in the course of the disease. It is usually self-limited and rarely requires therapy. |
| Question-A-Day
for Saturday: In patients with rhabdomyolysis, why should
treatment with calcium be avoided in asymptomatic hypocalcemic
patients? Answer: In these patients, calcium may raise intracellular calcium levels and promote further muscle injury. |
| Question-A-Day
for Sunday: What is the mainstay of therapy for
rhabdomyolysis? Answer: Administration of a large volume of intravenous fluid (usually normal saline) is the mainstay of therapy. It's purpose is to prevent the most lethal complication of rhabdomyolysis: acute renal failure. Effective therapy aims for a urine output of 200-300 cc/hour. Many advocate alkalinization of the urine as well. In an acid urine, myoglobin is toxic and uric acid can crystallize. |
Reprinted with permission from Question-A-Day (QAD), an online archive offering a daily question, answer and reference from Emergency Medicine core texts. QAD was created by Craig Feied, M.D., Director of the National Center for Emergency Medicine Informatics, and is edited by Jonathan Handler, M.D., Director of Research and Informatics at Northwestern University Department of Emergency Medicine. |
Related links on this site:
For journalistic case histories of rhabdomyolysis,
visit Seeing red, Anatomy
of an attack, Running
in the family, The
great Alaska kick-start.
For information about drugs that can trigger rhabdomyolysis, visit Just
say no.
To see a muscle slide of rhabdomyolysis,
visit In graphic
detail.
For more stories about rhabdomyolysis and CPT II deficiency,
visit First-person patient stories
and Mailbox. To read about
muscle cramps associated with rhabdomyolysis, visit When
exercise cramps your style.Related links on the internet: Pathogenesis and management of rhabdomyolysis 
Rhabdomyolysis: Medline Plus Health Information Rhabdomyolysis: Emergency medicine Rhabdomyolysis When exercise goes awry: Exertional rhabdomyolysis |
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