Rhabdomyolysis

From: Subject: Rhabdomyolysis Date: Thu, 25 Sep 2003 11:15:19 +0300 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_0000_01C38356.4E35F150"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1165 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C38356.4E35F150 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.spiralnotebook.org/rhabdomyolysis/ Rhabdomyolysis



Rhabdomyolysis:=20 Taking it one day at a time
--Jonathan A. = Handler,=20 M.D.

Question-A-Day for=20 Monday: What are the most common causes = of rhabdomyolysis?
Answer: = Alcohol, drugs,=20 infections, trauma and seizures are the leading causes of=20 rhabdomyolysis.

Question-A-Day for=20 Tuesday: How frequently are the classic complaints = of=20 myalgia (muscle pain) or muscle weakness seen in=20 rhabdomyolysis?
Answer: These symptoms are = unreliable. In=20 one study, only 50% of patients with proven rhabdomyolysis = had these=20 complaints.

Question-A-Day for=20 Wednesday: How frequently do patients with = rhabdomyolysis=20 present with the classic examination of the disorder: muscle = weakness, tenderness, and swelling with discoloration of = overlying=20 skin?
Answer: These signs are present less than = 20% of the=20 time (seen 4% to 15% of the time).

Question-A-Day for=20 Thursday: How sensitive is a urine dipstick for = blood in=20 detecting rhabdomyolysis?
Answer: The urine "dip" = for=20 blood is not only non-specific, it appears to lack adequate=20 sensitivity for diagnosis of this disorder. In one large = study,=20 about 1/4 of the patients with serologically proven = rhabdomyolysis=20 had negative "dips" for blood.

Question-A-Day for=20 Friday: What is the most commonly encountered = electrolyte=20 abnormality in rhabdomyolysis?
Answer: = Hypocalcemia (low=20 calcium) is the most commonly encountered electrolyte = abnormality in=20 this condition. It occurs very early in the course of the = disease.=20 It is usually self-limited and rarely requires = therapy.

Question-A-Day for=20 Saturday: In patients with rhabdomyolysis, why = should=20 treatment with calcium be avoided in asymptomatic = hypocalcemic=20 patients?
Answer: In these patients, calcium may = raise=20 intracellular calcium levels and promote further muscle=20 injury.

Question-A-Day for=20 Sunday: What is the mainstay of therapy for=20 rhabdomyolysis?
Answer: Administration of a large = volume=20 of intravenous fluid (usually normal saline) is the mainstay = of=20 therapy. It's purpose is to prevent the most lethal = complication of=20 rhabdomyolysis: acute renal failure. Effective therapy aims = for a=20 urine output of 200-300 cc/hour. Many advocate = alkalinization of the=20 urine as well. In an acid urine, myoglobin is toxic and uric = acid=20 can crystallize.

Reprinted with permission = from Question-A-Day=20 (QAD), an online archive offering a daily question, answer = and=20 reference from Emergency Medicine core texts. QAD was = created by=20 Craig Feied, M.D., Director of the National Center for = Emergency=20 Medicine Informatics, and is edited by Jonathan Handler, = M.D.,=20 Director of Research and Informatics at Northwestern = University=20 Department of Emergency Medicine.

Related links on this=20 site:

For journalistic case histories of = rhabdomyolysis, visit=20 Seeing=20 red, Anato= my=20 of an attack, Runn= ing=20 in the family, The=20 great Alaska kick-start.

For information about drugs that can trigger=20 rhabdomyolysis, visit Just say=20 no.

To see a muscle = slide of=20 rhabdomyolysis, visit In= =20 graphic detail.

For more stories about rhabdomyolysis and CPT II = deficiency, visit First-perso= n=20 patient stories and Mailbox.&nb= sp;

To read about muscle cramps associated with=20 rhabdomyolysis, visit When=20 exercise cramps your style.

Related links = on the=20 internet:
Pathogenesis=20 and management of rhabdomyolysis

Rhabd= omyolysis:=20 Medline Plus Health Information

Rhabdomyolysis:=20 Emergency medicine

Rhabdomyolysis=

When exercise = goes awry:=20 Exertional rhabdomyolysis

=A9 1999-2000 The Spiral = Notebook All Rights=20 Reserved

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