From the Guidelines
Yes, prolonged immobilization after a fall can lead to rhabdomyolysis (rhabdo), a serious condition where muscle tissue breaks down, releasing myoglobin and other cellular contents into the bloodstream. This occurs when sustained pressure on muscles from immobility causes muscle tissue breakdown. The risk increases with longer periods of immobility, especially if you're lying on a hard surface. Symptoms include muscle pain, weakness, dark urine, and confusion. If you suspect rhabdo after a fall, seek immediate medical attention.
Key Points to Consider
- Treatment typically involves IV fluids to prevent kidney damage, with normal saline being the standard fluid administered at rates determined by a healthcare provider based on severity, as seen in guidelines for acute care of severe limb trauma patients 1.
- Pain management may include medications like acetaminophen.
- Prevention involves changing positions regularly if possible and seeking help promptly after falls.
- The elderly, those with certain medical conditions, and people taking medications like statins face higher risks of developing rhabdo after immobility.
Importance of Early Detection and Management
Early detection of rhabdomyolysis is crucial, and it is recommended to perform repeated bio-assessment combining plasma myoglobin, plasma creatine phosphokinase (CPK), and kalaemia measurements, as well as bladder catheterization to monitor hourly urine output and urine pH, which should be maintained at 6.5 1.
Conclusion Not Needed, Direct Answer Provided Above
The most recent and highest quality study on this topic is from 2022, which emphasizes the importance of maintaining muscle mass and preventing immobilization in older persons to avoid muscle mass loss and related complications 1.
From the Research
Prolonged Immobilization and Rhabdomyolysis
- Prolonged immobilization after a fall can lead to rhabdomyolysis, a medical condition caused by muscle breakdown leading to potential renal damage 2, 3, 4.
- Rhabdomyolysis can result from various etiologies, including immobility, trauma, and genetic conditions, and can cause significant morbidity and mortality if not rapidly identified and treated 2, 5.
- The diagnosis of rhabdomyolysis is often determined with an elevated creatinine kinase greater than five times the upper-limit of normal, and treatment includes addressing the underlying etiology, as well as aggressive intravenous hydration 2, 5, 6.
Risk Factors and Complications
- Prolonged immobilization, especially in patients who are intoxicated or have altered mentation, can increase the risk of developing rhabdomyolysis 3, 4.
- Rhabdomyolysis can be complicated by acute renal failure, compartment syndrome, cardiac dysrhythmias, and disseminated intravascular coagulopathy 2, 5, 4.
- The mainstay of treatment is hospitalization with aggressive intravenous fluid resuscitation and correction of electrolyte abnormalities 5, 6.
Diagnosis and Treatment
- Serum creatine phosphokinase is the most sensitive marker of muscular damage, and its elevation can correlate with the amount of muscle injury and disease severity 4.
- Treatment of rhabdomyolysis includes immediate, aggressive intravenous volume expansion to prevent myoglobinuric renal failure, and serum potassium levels must be obtained to identify life- and limb-threatening complications of hyperkalemia 3.
- Hemodialysis may be required in some cases, but the renal prognosis is generally good with supportive treatment and correction of electrolyte abnormalities 6.