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Rhabdomyolysis
- Massive necrosis of muscle cells leading to weakness, myalgia, and swelling
- Myoglobin can damage renal tubules and cause AKI
- Also leads to electrolyte derrangements from cell lysis such as hyperkalemia, hyperphosphatemia and hypocalcemia (from chelation). Can also see elevated AST out of proportion to ALT
- Diagnosis is made when UA shows positive hemoglobin (heme pigment) but few RBCs and there are elevated levels of CPK
Posted 07/07/16 09:34:11 AM by Ying Liu
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Risk Factors
- Drug Use/Cocaine
- Seizures
- Being dry increases your risk of kidney damage from rhabdo
- Meds -> particularly simvastatin in this case
Posted 07/07/16 09:39:26 AM by Ying Liu
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Treatment:
- Hydration is mostly to prevent renal failure and increase urine output
- Once oliguric, can give fluid challenge but if urine output doesn't improve, there may already be acute tubular necrosis. Then, you should be careful with fluids to avoid volume overload
- If severe AKI and no urine output, initiate renal replacement therapy
- Fasciotomy for compartment syndrome to avoid more damage
Posted 07/07/16 09:43:45 AM by Ying Liu
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- CVVH - Continuous Venovenous Hemofiltration
- Filtration only
- Uses hydrostatic pressure to ultra-filter blood to remove volume and at the same time it will clear electrolytes
- Large molecules are often cleared faster
- Will replace fluid directly into the blood
- CVVHD - Continuous Venovenous Hemodialysis
- Involves dialysate (bath of electrolytes) that allows diffusion of electrolytes
- Can change blood flow rate for faster fluid exchange
- Better for electrolyte normalization
- HD - Hemodialysis
- The best mode if tolerated by blood pressure as you can manage electrolytes and remove fluids much more efficiently
Posted 07/07/16 09:50:29 AM by Ying Liu
Created by Christopher Kelly
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.
