Search

Introduction: Rhabdomyolysis induced acute kidney injury (AKI) develops due to leakage of the potentially nephrotoxic intracellular content into the circulation. This study aimed to evaluate the prevalence and predictive factors of AKI in Kermanshah earthquake victims., Methods: This cross-sectional study was performed on victims of 2017 Kermanshah earthquake, Iran, who were admitted in Kermanshah and Tehran Hospitals. Data of the hospitalized patients were gathered and the prevalence of rhabdomyolysis induced AKI was studied. In addition, correlations of various clinical and laboratory variables with rhabdomyolysis induced AKI were assessed., Results: 370 hospitalized patients with the mean age of 39.24 ± 20.32 years were studied (58.6% female). 10 (2.7% of all admitted) patients were diagnosed with AKI. Time under the rubble (p < .0001), serum level of creatinine phosphokinase (CPK) (p < .001), lactate dehydrogenase (LDH) (p < .0001), aspartate aminotransferase (AST) (p = .001) and uric acid (p = .003) were significantly higher in patients with AKI. Area under the ROC curves of CPK, LDH, AST, and uric acid for predicting the risk of developing AKI were 0.883 (95% CI: 0.816-0.950), 0.865 (95% CI: 0.758-0.972), 0.846 (95% CI: 0.758-0.935), and 0.947 (95% CI: 0.894-0.100), respectively. The best cutoff points for CPK, LDH, AST, and uric acid in this regard were 1656 IU/L, 839.5 U/L, 46.00 IU/L, and 5.95 mg/dL., Conclusion: The rate of traumatic rhabdomyolysis induced AKI development was estimated to be 2.7%. Time under the rubble and serum levels of CPK, LDH, AST, and uric acid were identified as the most important predictive factors of AKI development., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Rhabdomyolysis is a medical condition caused by muscle breakdown leading to potential renal damage. This can result in significant morbidity and mortality if not rapidly identified and treated., Objective: This article provides an evidence-based narrative review of the diagnosis and management of rhabdomyolysis, with focused updates for the emergency clinician., Discussion: Rhabdomyolysis is caused by the breakdown of muscle cells leading to the release of numerous intracellular molecules, including potassium, calcium, phosphate, uric acid, and creatinine kinase. There are a number of potential etiologies, including exertion, extreme temperature changes, ischemia, infections, immobility, drugs, toxins, endocrine causes, autoimmune reactions, trauma, or genetic conditions. Findings can include myalgias, muscle weakness, or dark-colored urine, but more often include non-specific symptoms. The diagnosis is often determined with an elevated creatinine kinase greater than five times the upper-limit of normal. Severe disease may result in renal failure, electrolyte derangements, liver disease, compartment syndrome, and disseminated intravascular coagulation. Treatment includes addressing the underlying etiology, as well as aggressive intravenous hydration with a goal urine output of 300 mL/h. Bicarbonate, mannitol, and loop diuretics do not possess strong evidence for improved outcomes. Renal replacement therapy should be determined on a case-by-case basis. Most patients are admitted, though some may be appropriate for discharge., Conclusion: Rhabdomyolysis is a potentially dangerous medical condition requiring rapid diagnosis and management that may result in significant complications if not appropriately identified and treated. Emergency clinician knowledge of this condition is essential for appropriate management., (Published by Elsevier Inc.)

Acute rhabdomyolysis is a rare phenomenon in the emergency setting almost exclusively associated with trauma, drugs, and recent upper respiratory and gastrointestinal infection. Rare reports in the literature have highlighted adult patients presenting with rhabdomyolysis as 1 component in a constellation of symptoms in acute HIV-1 seroconversion; however, there are few reports of rhabdomyolysis as the sole presenting symptom. This case highlights the importance of investigating HIV and other sexually transmitted diseases in pediatric cases of rhabdomyolysis in the emergency care setting.

Study Objectives: Hematuria by urine dipstick with absent red blood cells (RBCs) on microscopy is indicative of rhabdomyolysis. We determined the sensitivity of this classic urinalysis (UA) finding in the diagnosis of rhabdomyolysis., Methods: We conducted a retrospective electronic medical record review of patients with a primary or secondary diagnosis of rhabdomyolysis with a creatine phosphokinase (CPK) greater than 1000 IU/L and a UA within the first 24 hours. Data were collected using a standardized data form, and a blinded panel of 3 emergency medicine physicians reviewed selected cases. Sensitivity and 95% confidence intervals (CIs) were calculated for detection of rhabdomyolysis by UA., Results: During the study period, 1796 patients were diagnosed with rhabdomyolysis, of whom 228 met inclusion criteria. The mean peak CPK was 27509 IU/L. One hundred ninety-five (86%) had a urine dip-positive for blood. However, only 94 patients (41%) had a positive urine dip and negative microscopic hematuria, resulting in a sensitivity of 41% (95% CI, 35%-47%). In a subset of 66 patients (29%) with more severe rhabdomyolysis (initial CPK, ≥10000 IU/L; mean CPK, 53365 IU/L), UA had a sensitivity of 55% (95% CI, 43%-67%). Broadening the definition of negative microscopy from 0 to 3 RBCs to less than 10 RBCs only increased the sensitivity to 79% (95% CI, 73%-83%)., Conclusions: The combination of a positive urine dip for blood and negative microscopy is an insensitive test for rhabdomyolysis, and the absence of this finding should not be used to exclude the diagnosis., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: This study aimed to determine the clinical factors in predicting acute renal failure (ARF) in rhabdomyolysis and investigate the potential risk of renal replacement therapy (RRT)., Basic Procedures: From 2006 to 2011, we retrospectively analyzed 202 patients 65 years or younger with a definite diagnosis of rhabdomyolysis and serum creatinine phosphokinase levels greater than 1000 IU/L. The related clinical factors were analyzed in the patients with ARF caused by rhabdomyolysis. In addition, receiver operating characteristic curves were used to establish the appropriate cutoff values of serum biomarkers in predicting ARF., Main Findings: The most common causes of rhabdomyolysis were trauma (n = 54; 26.7%) and infections (n = 37; 18.3%). Of the 202 patients, 29 (14.4%) developed ARF, and RRT was indicated for 5 of these 29 patients. Predictive factors for ARF were dark urine, initial and peak serum myoglobin level, rhabdomyolysis caused by body temperature change, and an elevated serum potassium level. Receiver operating characteristic analysis showed that the best cutoff value of initial serum myoglobin level for predicting ARF was 597.5 ng/mL. Risk factors for RRT in patients with ARF were etiologies of rhabdomyolysis, peak blood urea nitrogen and creatinine levels, and the creatinine phosphokinase level on the third day as rhabdomyolysis developed., Principal Conclusions: Age, dark urine, etiologies, serum levels of blood urea nitrogen, creatinine and potassium, and initial and peak serum myoglobin levels may serve as important factors in predicting ARF in patients with rhabdomyolysis. We suggest that the appropriate cutoff value of initial serum myoglobin for predicting ARF is 600 ng/mL., (Copyright © 2013 Elsevier Inc. All rights reserved.)

A 60-year-old man with renal failure and intraabdominal abscess formation probably due to perforation of the colon underwent laparotomy on the sixth hospital day. He developed respiratory infection, deterioration of renal failure, and heart failure resulting in severe respiratory insufficiency after laparotomy. He was placed on mechanical ventilation using sedatives and muscle relaxant and was treated with antibiotics, steroids, and a diuretic. The value of serum sodium jumped from 146 to 164 mEq/L in 2 days. Sodium infusion was discontinued, and hypernatremia decreased. He fell into a coma and demonstrated generalized convulsions after mechanical ventilation was discontinued. His head computed tomography did not indicate any pathologic findings, and his convulsions were not controlled so that he was again placed on mechanical ventilation. The laboratory findings revealed rhabdomyolysis (18936 IU/L) 5 days after the normalization of hypernatremia. Mechanical ventilation and hemodialysis were terminated after the convulsions were controlled and the renal failure improved on the 82nd hospital day. Head magnetic resonance imaging exhibited that multiple hyperintensity lesions in the white matter with linear signal changes in both occipital cortex. He remained unconscious for 6 months. This is the first case that demonstrated demyelination, laminar cortical necrosis, and rhabdomyolysis associated with hypernatremia. Rhabdomyolysis after rapid occurrence of hypernatremia might be a laboratory sign of concomitant demyelination.

Objective: Cardiac troponin I (cTnI) is considered the most specific marker of cardiac muscle injury. We encountered several patients with rhabdomyolysis and elevated cTnI, although they did not otherwise have evidence of cardiac injury. We determined the prevalence of false-positive cTnI in emergency department (ED) patients with rhabdomyolysis., Methods: We conducted a retrospective cohort study of ED patients admitted with a diagnosis of rhabdomyolysis. Patients were included in the study if they had a serum creatine kinase (CK) of 1000 U/L or greater and at least one serum cTnI determination. Patients with positive cTnI were considered true positives if they had either electrocardiography (EKG) or echocardiography abnormalities; false positives if both the EKG and the echocardiography were considered normal; or indeterminate if they did not have both an EKG and an echocardiogram. The primary outcome of the study was the prevalence of false-positive cTnI. Secondary outcomes included risk stratification by cocaine use, myoglobinuria, and renal failure and correlation of peak CK and troponin levels., Results: One hundred nine patients were included in the final analysis; 55 (50%) patients had a positive cTnI. Of the 55 patients with positive cTnI, 32 (58%) were true positives, 18 (33%) were false positives, and 5 (9%) were indeterminate. The prevalence of false-positive cTnI was 17% (18/109, 95% confidence interval 0.10-0.25). There was no association between false-positive cTnI and cocaine use, renal failure, or myoglobinuria. There was poor correlation between peak CK and peak cTnI levels (r = -.08, 95% confidence interval -0.34 to 0.19)., Conclusion: The prevalence of false-positive cTnI in ED patients with rhabdomyolysis is 17%.

A patient presented with infectious mononucleosis complicated by acute rhabdomyolysis following physical exertion. This infrequent complication should be identified and treated quickly to prevent serious sequelae of rhabdomyolysis, which may include renal failure and disseminated intravascular coagulation.