Rhabdomyolysis (cont.)

One of the dreaded complications of rhabdomyolysis is kidney failure. This can occur for a variety of reasons. Direct injury to the kidney and plugging of the filtering tubes of the kidneys by the muscle proteins are among the causes of kidney function impairment in the setting of rhabdomyolysis.

Another serious complication of rhabdomyolysis is called the compartment syndrome whereby muscle injury leads to swelling and increased pressure in a confined space (a compartment). This leads to compromised circulation which can endanger the affected tissue. The compartment syndrome is most common after injury in the lower leg or the muscles of the abdominal wall and can require emergency surgery.

Rhabdomyolysis can also cause abnormality of electrolytes in the blood. Because of muscle injury, the contents of the muscle cells can be released into the blood causing high levels of potassium (hyperkalemia) and phosphorus (hyperphosphatemia).

The treatment of rhabdomyolysis depends on its cause and severity.

If a cause for rhabdomyolysis is identified, it is addressed; for example:

• discontinuing a toxic medication,
  
  
• replacing electrolytes, or
  
  
• treating an underlying muscle disease.

In cases of mild rhabdomyolysis without any evidence of complications, management can take place at home by simply recognizing the cause and correcting it, such as discontinuing a medication and rehydration.

In more severe cases, or if home therapy is not possible, hospitalization may be required. Prompt initiation of hydration with intravenous fluids, in addition to the removal the provoking factor(s), is an essential part of the treatment of rhabdomyolysis. Monitoring and managing kidney dysfunction, correcting any disturbance in the electrolytes, and monitoring the muscle enzyme levels (CPK, SGOT, SGPT, LDH) are most effectively done in the hospital when rhabdomyolysis is severe.

Source: MedicineNet.com
http://www.medicinenet.com/rhabdomyolysis/article.htm