• 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

• 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

• 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

• Types of RRT (Renal Replacement Therapy)
  • 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

Know a hypochondriac? Get them the best-selling book 'AM I DYING?!: A Complete Guide to Your Symptoms, and What to Do Next'
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.