Acute Rhabdomyolysis?

Nurse Ratched, RN · Aug 14, 2004

http://www.nlm.nih.gov/medlineplus/ency/article/000473.htm

I've seen it in our addictions population. Very dangerous. Always elicits an "oh, crap" when you realize someone has it.

VickyRN, MSN, DNP, RN · Aug 14, 2004

Can be a rare (and deadly) side-effect of statin medications. That's why Baycol was pulled off the market.

Toby's mum · Aug 14, 2004

http://www.nlm.nih.gov/medlineplus/ency/article/000473.htm
I've seen it in our addictions population. Very dangerous. Always elicits an "oh, crap" when you realize someone has it.

Nurse Ratched--thanks for giving us this url. Based on the info, would you think in this particular case it may have been from strenuous athletic exercise and perhaps frequent dehydration (assuming it is not drug related)? Also, do you have any idea over what time period this would have to take place for him to first experience symptoms (which were severe by the sound of it)? Would this be reverseable? Sounds like a horrible situation for this young adult.

Thanks for your thoughts on the above.

NeuroICURN · Aug 14, 2004

Forgive the quick response, but I'm running short on time here......

Yes, I actually just had a pt. with it about 2 weeks ago....was a man who fell and was down for approx. 24 hours before being found. Yes, it is very serious stuff.

JJRN · Aug 14, 2004

I have cared for numerous pt's c rhabdo. Can be common in traumatic crush injuries or any other problem that can increase an extremities compartment pressures resulting in breakdown of myocytes (or just excessive muscle breakdown). This releases myoglobin, which is too large for renal excretion. It builds up and essentially clogs the kidneys...resulting in renal failure. These pt's require CVVHD and obviously fixing of the source...possibly a decompressive fasciotomy. Also problem c burn patients. Relating to the case discussed above, I did know two pt's who were training for a SWAT team (excessive muscle building), and were taking creatine (that muscle building supplement?). They developed compartment syndrome of their thighs, needed fasciotomies, dialysis, couple OR trips, were intubated for a while, and I think one ultimately lost the involved extremity.

chris_at_lucas_RN, RN · Aug 14, 2004

I had a fellow with that diagnosis last summer.

He was in his 90's, never sick a day in his life, took no meds, not even vitamins. Tripped on his way out the back door and fell, and lay there in teh sunshine (which can be pretty horrific in Texas in the summer) for about four hours before his son found him.

His urine was OK when I saw him (light yellow and enough of it), he felt good, no pain or discomfort, appetite good, he wanted to go home!!! His labs were off (couldn't tell you now in what direction) so they kept him in the hospital.

hoolahan, ASN, RN · Aug 15, 2004

I have seen this several times too in post-op open hearts. Usually in the leg, if they have been shocky or very edemetous, ot had bleeding into the donor leg. Edema of tissues in those cases led to compression of microcircuolation which begins the breakdown of mycytes as described about. They usually required some form of temporary dialysis, fasciotomies, which are soooo hard to keep from getting infected, where they will make alarge incision in the fascia the length of the muscle compartment. One pt I remember had 3 fasciotomies on each calf. What a messy weeping dressing change.

One pt actually developed a compartment syndrome in his gluteals after being in the OR so long. He was also very unstable post-op, and couldn't even tolerate being turned without bottoming out his pressure. He lingered for a long time, but eventually died. In his case, I think rhabdo was the least of his problems, and that is pretty bad.

I have read that it can occur from strenuous exercise.

rEAL nUT · Aug 15, 2004

I have only taken care of one pt with rhabdo. He was a mva pt who was dx with this after being treated in the ICU for his injuries and shock. He received HD temp. and I have not heard anything about him lately, but he was eventually sent to the step down unit and discharged from the hospital. I doubt he is still receiving HD at this point.

Ebeza · Aug 15, 2004

I had a new admit come in with this in middle of the night. Female, 40's pscyh hx. I needed a brush up and asked the intern what we should be watching for: She said the protein in her body was breaking down and they wanted to flush her kindneys that's why the NS was running at 250 cc hr. Yeah, I went and got an imed controller. she was gone the next night so I don't know what happened to her-- (transferred)

redwinggirlie · Aug 15, 2004

Here in Arizona, we see a lot of this due to people coming across the border from Mexico who have been wandering in the desert for days. Sad cases

Uptoherern, RN · Aug 15, 2004

had a lady just tonight with a ck of 7055. Not near as high as I've seen. She was polysubstance abuse and was found by a neighbor/friend in her bathroom sitting on the toilet ALOC. Four hours after being in ER, she still had a red toilet ring on her behind. Who knows how long she'd been sitting there! She tested pos. for benzo's and opiates. Had her own little pharmaceutical. Had another guy a few years back....homeless, found down. ck of more than 27,000. Had a seizure and died.