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Rhabdomyolysis: historical background, clinical, diagnostic and therapeutic features
-
Gianfranco Cervellin
Veröffentlicht/Copyright:
19. März 2010
Abstract
Rhabdomyolysis, a term used to describe the rapid breakdown of striated muscle, is characterized by rupture and necrosis of muscle fibers. This process results in the release of cell breakdown products into the bloodstream and extracellular space. Although direct muscle injury remains the most common cause of muscle injury, additional causes include hereditary enzyme disorders, drugs, toxins, endocrinopathies, malignant hyperthermia, neuroleptic malignant syndrome, heatstroke, hypothermia, electrolyte alterations, diabetic ketoacidosis and non-ketotic hyperosmolar coma, severe hypo- or hyperthyroidism and bacterial or viral infections. The classic triad of symptoms includes muscle pain, weakness and dark urine, although more than 50% of the patients do not complain of muscle pain or weakness. Additional systemic symptoms include fever, general malaise, tachycardia, nausea and vomiting. The laboratory diagnosis is based essentially on the measurement of creatine kinase in serum or plasma. Plasma and urine myoglobin measurement might be useful in the early stages of the syndrome and for identifying a subset of patients with minor skeletal muscle injury. Patient monitoring is pivotal (the mortality rate is as high as 8%), and should be focused on preventing the detrimental consequences, that often include renal disease and coagulopathy. In the pre-hospital setting, forced hydration with 1.5–2 L of sterile saline solution should be started immediately, followed by 1.5–2 L/h. Following hospital admission, continuous hydration should be ensured, alternating the saline solution with a 5% glucose solution. In the presence of myoglobinuria, urine should be alkalinized by use of sodium bicarbonate solution.
Clin Chem Lab Med 2010;48:749–56.
Received: 2009-11-17
Accepted: 2009-12-4
Published Online: 2010-03-19
Published in Print: 2010-06-01
©2010 by Walter de Gruyter Berlin New York
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Schlagwörter für diesen Artikel
creatine kinase;
crush injury;
crush syndrome;
rhabdomyolysis;
trauma
Artikel in diesem Heft
- Editorials
- The “Obamanomics”: a revolution in laboratory diagnostics
- Skeletal muscle biomarkers: not new but still interesting diagnostic tools
- Necessity for high-quality reference materials in the harmonization of laboratory assays
- Reviews
- Rhabdomyolysis: historical background, clinical, diagnostic and therapeutic features
- Biochemical markers of muscular damage
- Minireview
- Interpretation of serum parathyroid hormone concentrations in dialysis patients: what do the KDIGO guidelines change for the clinical laboratory?
- Guidelines and Recommendations
- 2010 Consensus statement on the worldwide standardization of the hemoglobin A1c measurement
- Genetics and Molecular Diagnostics
- Development of a low-cost real-time reverse transcriptase-polymerase chain reaction technique for the detection and quantification of hepatitis C viral load
- Microsatellite polymorphisms in intron 2 of the toll-like receptor 2 gene and their association with susceptibility to pulmonary tuberculosis in Han Chinese
- Evaluation of a panel of circulating DNA, RNA and protein potential markers for pathologies of pregnancy
- General Clinical Chemistry and Laboratory Medicine
- Traceability of values for catalytic activity concentration of enzymes: a Certified Reference Material for aspartate transaminase
- Development and preparation of a new serum protein reference material: feasibility studies and processing
- A WHO Reference Reagent for the Serum Transferrin Receptor (sTfR): international collaborative study to evaluate a recombinant soluble transferrin receptor preparation
- Hyperhomocysteinemia is not associated with reduced bone quality in humans with hip osteoarthritis
- Diagnostic performance of anti-citrullinated peptide antibodies for the diagnosis of rheumatoid arthritis: the relevance of likelihood ratios
- New quantitative electrochemiluminescence method (ECLIA) for interleukin-6 (IL-6) measurement
- Evaluation of cell counting and leukocyte differentiation in cerebrospinal fluid controls using hematology analyzers by the German Society for Clinical Chemistry and Laboratory Medicine
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- Letters to the Editor
- Hemolysis correction factor in the measurement of serum neuron-specific enolase
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