Abstract
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.
Keywords
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Article Info
Publication History
Published online: January 02, 2019
Accepted:
December 31,
2018
Received in revised form:
December 20,
2018
Received:
November 2,
2018
Identification
Copyright
Published by Elsevier Inc.
