Scientific Article By Assist Lecturer Ola Abbas Khdhair Titled As:- Rhabdomyolysis Date: 31/12/2022 | Views: 369

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Rhabdomyolysis
Rhabdomyolysis is a complex medical condition involving the rapid dissolution of damaged or injured skeletal muscle. This disruption of skeletal muscle integrity leads to the direct release of intracellular muscle components, including myoglobin, creatine kinase (CK), aldolase, and lactate dehydrogenase, as well as electrolytes, into the bloodstream and extracellular space.
Rhabdomyolysis ranges from an asymptomatic illness with elevation in the CK level to a life-threatening condition associated with extreme elevations in CK, electrolyte imbalances, acute renal failure (ARF), and disseminated intravascular coagulation. Although rhabdomyolysis is most often caused by direct traumatic injury, the condition can also be the result of drugs, toxins, infections, muscle ischemia, electrolyte and metabolic disorders, genetic disorders, exertion or prolonged bed rest, and temperature-induced states such as neuroleptic malignant syndrome (NMS) and malignant hyperthermia (MH). Massive necrosis, manifested as limb weakness, myalgia, swelling, and commonly gross pigmenturia without hematuria, is the common denominator of both traumatic and nontraumatic rhabdomyolysis.
The earliest known description of this condition appears in the Old Testament’s Book of Numbers that records a plague suffered by the Jews during their exodus from Egypt after consuming large amounts of quail. The plague is widely assumed to be a reference to the signs and symptoms of myolysis, a long-observed outcome in the Mediterranean after the intake of quail.
Myolysis seemingly occurs because of the poisonous hemlock that quail consume during the spring migration. In modern times, one of the first medical descriptions of rhabdomyolysis is in German medical literature from the early 1900s, where it is termed Meyer-Betz disease.

Bywaters and Beall are often credited with the first account of the pathophysiologic mechanisms of the syndrome and the accurate depiction of the link between rhabdomyolysis and ARF.
Theoretically, any form of muscle damage and, by extension, any entity that leads to or causes muscle damage, can initiate Rhabdomyolysis. In adults, the available data show that the most common causes of Rhabdomyolysis are drug or alcohol abuse, medicinal drug use, trauma, NMS, and immobility. The data in the pediatric population skew toward different leading causes, suggesting that viral myositis, trauma, connective tissue disorders, exercise, and drug overdose are responsible for much of the rhabdomyolysis seen in these patients; viral myositis alone may account for up to one-third of pediatric cases of rhabdomyolysis.
Clinically, rhabdomyolysis is exhibited by a triad of symptoms: myalgia, weakness, and myoglobinuria, manifested as the classically described tea-colored urine. However, this rigid depiction of symptoms can be misleading as the triad is only observed in 50% of patients do not complain of muscle pain or weakness, with the initial presenting symptom being discolored urine. An elevated CK level is the most sensitive laboratory test for evaluating an injury to muscle that has the potential to cause rhabdomyolysis (assuming no concurrent cardiac orbrain injury).\ Attempts to correlate the elevation in CK level with the severity of muscle damage and/or renal failure have had mixed results, although significant muscle injury is likely at CK levels >5,000 IU/L.
Treatment for rhabdomyolysis, at least initially, is mainly supportive, centering on the management of the ABCs (airway, breathing, circulation) and measures to preserve renal function, including vigorous rehydration.



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