From the Guidelines
Rhabdomyolysis in young patients is primarily caused by traumatic injury, excessive physical activity, or certain medications and toxins.
Etiology
The etiology of rhabdomyolysis can be multifactorial, including:
- Traumatic injury, such as limb trauma 1
- Excessive physical activity
- Certain medications, such as statins
- Toxins, such as alcohol or cocaine
Appropriate Workup
The appropriate workup for rhabdomyolysis in a young patient includes:
- Laboratory tests:
- Serum creatine kinase (CK) levels to confirm muscle damage
- Electrolyte panel to assess for imbalances
- Renal function tests, such as serum creatinine and urine output, to monitor for acute kidney injury (AKI) 1
- Urinalysis: to check for myoglobinuria, which can indicate rhabdomyolysis
- Imaging studies: such as X-rays or CT scans, to assess for traumatic injuries or other underlying causes It is essential to promptly identify and manage rhabdomyolysis to prevent complications, such as AKI, which can be detected and prevented with proper monitoring and intervention 1.
From the Research
Etiology of Rhabdomyolysis
- Rhabdomyolysis can result from various underlying etiologies, including traumatic causes such as crush injury 2, non-traumatic causes such as strenuous exercise 3, and other factors like drug overdose, immobilization, sepsis, and alcohol consumption 4, 5.
- The condition may also be associated with genetic factors, as suggested by the presence of a heterozygous deletion in the LPIN1 gene in one of the cases reported by 3.
Clinical Presentation
- Rhabdomyolysis typically presents with symptoms such as muscle pain, weakness, and dark urine, accompanied by elevated creatine kinase (CK) levels 2, 5.
- The condition may also be characterized by disruptions in fluid balance, electrolytes, and renal function, leading to complications like acute renal failure (ARF) 2, 4.
Diagnosis and Workup
- Diagnosis of rhabdomyolysis is typically made through the timely determination of serum creatine kinase activity in a patient with a suggestive history or clinical features 2.
- A high level of suspicion and appropriate sensitivity to abnormal laboratory values are required for diagnosis, as the condition may occur with minimal symptoms or physical findings 4.
- CK values are used for diagnosis and prognosis, with renal dysfunction being the most serious complication 5.
Treatment and Management
- Treatment of rhabdomyolysis is supportive, with generous intravenous hydration and correction of electrolyte abnormalities being the mainstay of therapy 2, 5.
- In some cases, haemofiltration or dialysis may be required, but the renal prognosis is generally good 2.
- The use of dexamethasone in conjunction with standard therapy has been considered in some cases, with reported benefits in reducing CK values and relieving patient symptoms 3.