Rhabdomyolysis

Definition/Etiology:

• Rhabdomyolysis (rhabdo)
  • Breakdown of the muscle resulting in kidney injury or failure.
• Causes:
  • Elderly (fall, cannot get up, found after extended period of time)
  • Firefighters (overheated)
  • Endurance athletes (extreme workouts)
  • Military (boot camp)

Pathophysiology:

• Muscles breakdown –release myoglobin 
• Muscles swell –dehydration
• Kidneys – cannot filter extra myoglobin and damaged from dehydration start shutting down

Muscles breakdown, release myoglobin and swell. Fluid is in the wrong place, so dehydration occurs. Kidneys cannot handle the extra myoglobin and lack of fluid, so they start to shut down.

Noticing: Assessment & Recognizing Cues:

• Muscle swelling
• Sore, tender muscles
• Dark or tea-colored urine

Interpreting: Analyzing & Planning:

• Urinalysis (myoglobin levels)
• Blood tests
  • Creatinine Kinase (CK) level
  • Blood Urea Nitrogen (BUN)
  • Creatinine
  • Muscle biopsy

Responding: Patient Interventions & Taking Action:

• IV fluids (A LOT)
• Monitor labs for improvement
• Hemodialysis temporarily or permanent

Reflecting: Evaluating Patient Outcomes:

• Kidney function improves?
• Education to prevent rhabdo
  • Gradually increase exercise regimen
  • Maintain hydration status
  • Avoid/minimize the previous trigger

Linchpins (Key Points):

• Rhabdo needs fluids, yo!
• Rhabdo = kidney and muscle injury
• Muscles= release myoglobin and swell (causing the dehydration)
• Kidneys= Dehydration and filtering (too much to handle!)
• Treatment= IV fluids