Rhabdomyolysis

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Classification according to ICD-10
M62.89 Other specified muscle disorders, unspecified sites
T79.6 Traumatic muscle ischemia
ICD-10 online (WHO version 2019)

In medicine, rhabdomyolysis is the term used to describe the dissolution of striated muscle fibers . These include the skeletal muscles as well as the heart muscles and diaphragm .

causes

Traumatic or through external influences

  1. Injuries, whereby injured muscle fibers are eliminated after an accident (e.g. crush syndrome )
  2. Electric shock
  3. After operations
  4. After seizures
  5. Compartment Syndrome
  6. By lying down for a long time
  7. After intensive training such as B. CrossFit , Body Building or Cycling / Spinning, especially for beginners or after a long break from training. If used improperly, EMS training in particular can quickly lead to increased creatine kinase levels in the blood.

Non-traumatic causes

  1. Medicines / drugs, e.g. B. Neuroleptics (see also Neuroleptic Malignant Syndrome ), preparations for lowering cholesterol ( statins , e.g. Cerivastatin ), sleeping pills , tocolytics (e.g. ritodrine), isotretinoin , propofol , cocaine
  2. Malignant hyperthermia
  3. Binge drinking
  4. Infectious , especially through viral infections
  5. Electrolyte disorder
  6. Muscle inflammation
  7. Metabolic disorders , e.g. B. Myophosphorylase deficit ( McArdle disease ), carnitine Palmityltransferase 2 (CPT 2) -deficient
  8. Autoimmune diseases
  9. Endocrinopathies
  10. Sickle cell crises
  11. Gas fire
  12. Snake poisons
  13. Mushroom poisons , e.g. B. Greenling (Tricholoma equestre)
  14. Coturnismus (quail poisoning )

Diagnosis

Mild rhabdomyolysis is often only detected by an increased concentration of enzymes in the blood that are normally found in muscles . These enzymes include creatine kinase (CK) and lactate dehydrogenase (LDH). A high concentration of myoglobin in the blood also leads to myoglobinuria , i.e. the excretion of myoglobin through the kidneys . The urine turns red-brown as a result.

Complications

A dreaded complication of rhabdomyolysis is acute kidney failure : the released myoglobin can damage the kidneys ( acute tubular necrosis ). It does this in three ways:

  1. The heme contained in myoglobin can clog the renal tubules with pigment cylinders;
  2. Iron is released and damages the tubular cells ;
  3. The displacement of fluid into the damaged muscle can lead to a lack of volume in the vessels and thus to a reduced blood flow to the kidneys.

treatment

A causal treatment is not available. However, rhabdomyolysis usually develops over a longer period of time and can possibly be reversed if the triggering factors are stopped in good time. Forced diuresis is necessary to prevent damage to the kidneys . The patient is given several liters of fluid in the form of infusions and urine excretion is stimulated by loop diuretics . This is supposed to accelerate the elimination of myoglobin and at the same time dilute the myoglobin in the urine. The urine can also be made alkaline in order to prevent the myoglobin from precipitating in an acidic environment. In extreme cases, dialysis can be used to remove the harmful myoglobin from the blood.

literature

  • Ana L. Huerta-Alardín, Joseph Varon, Paul E. Marik: Bench-to-bedside review: Rhabdomyolysis - an overview for clinicians . In: Critical Care . tape 9 , no. 2 , April 2005, p. 158-169 , doi : 10.1186 / cc2978 , PMID 15774072 .
  • Dieter Pongratz, Stephan Zierz: Neuromuscular diseases . Deutscher Ärzte Verlag, 2003, ISBN 3-7691-1172-9 ( preview in Google book search).

Web links

Wiktionary: Rhabdomyolysis  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. Robert Bublak: muscle breakdown after the power-kicking. In: Orthopedic Sports Medicine / News. September 4, 2017. Retrieved September 8, 2017 .
  2. Jump up Lorenzo Verriello, Domenico D'Amico, Giada Pauletto, Gian Luigi Gigli, Paolo Bergonzi: Rhabdomyolysis caused by tocolytic therapy with ritodrine hydrochloride. In: Neuromuscular Disorders. 19, No. 10, October 2009, doi: 10.1016 / j.nmd.2009.06.364 .
  3. Xavier Bosch, Esteban Poch, Josep M. Grau: Rhabdomyolysis and Acute Kidney Injury . In: New England Journal of Medicine . tape 361 , no. 1 , July 2, 2009, p. 62-72 , doi : 10.1056 / NEJMra0801327 .
  4. Claudio Ronco: Extracorporeal therapies in acute rhabdomyolysis and myoglobin clearance . In: Critical Care . tape 9 , no. 2 , p. 141 , doi : 10.1186 / cc3055 .