Acute Rhabdomyolysis?

Nurse Ratched, RN · Aug 15, 2004

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?[/quote']
Good question on the time frame - I really don't know. As someone else posted about their patient being found down, that's how so many of ours arrive, with no clue how long it's been. Since the vast majority in my experience have had to deal with addictions, it's not unusual for them to have been in altercations, and oftentimes the trauma may be a contributing factor.
In this young man, it sure does sound like dehydration/overstrain may have been the cause.

JJRN · Aug 15, 2004

Speaking of being found down, likely for and extended period...You've gotta love the families of alcoholic patients who step over their body for days as it lay at the bottom of the stairs. And it's hard to really blame them when they state they were not concerned because they were always passed out all over the place when he drank like like that, and they saw his chest rise occasionally. Oh, and there were these linear abrasions/bruising where his shoulder meets the neck...the culprit...swinging open of the front door so people could gain entry to the house. It smacked him every time. Bad, bad rhabdo...

adidas99 · Aug 15, 2004

Ya, the 18 yo i had, the doctor even said it was due to dehydration/over exertion.

CEN35 · Aug 16, 2004

It can occur for any reason that causes severe muscle breakdown, and acidosis. When I was in the ER, 98% of the rhabdo came from older dehydrated/heatstroked older people and/or older people that had CVA's or GIB's, and hit the floor unconcious, and were stuck there for more than 12-18 hours without moving an inch. Obviously the longer the time, the worse the problem became.

The worst and longest?

69yo, female GIB, passed out and hit the floor. Lied their for three days in 80's heat, incontinent during that period.

Creat > 7.0

BUN 117

No prior renal failure Hx

CK > 2000

Myglobin 1900's

Fgr8Out · Aug 16, 2004

We treat many of our traumatic crush injuries preemptively for rhabdo, according to a protocol designed by one of our trauma surgeons. I've seen cases from MVA's, from vascular occlusions following grafts, and due to prolonged immobility with/without anoxia, as many of you have reported. My most recent rhabdo patient was this past week... drug OD, unconscious for at least 12 hours... ck>10,000, bun/creatinine out the roof. Anoxic brain is going to be his ongoing issue... a shame, nice looking young man with a great future ahead of him... past tense, of course :stone

Pediatric Critical Care Columnist · Aug 16, 2004

Last year we had a patient who developed severe rhabdo following a heart transplant. There's a chance that she had malignant hyperthermia that went unnoticed because she was on bypass and had been cooled for the surgery. She came back with a CK >50,000 and a serum K+ of 16!! She suffered permanent muscle necrosis and was on dialysis for months. She had every complication that could possibly happen and nearly died several times. She's now essentially a quad...

alyca · Aug 16, 2004

We had a kid who was a bodybuilder, taking lots of creatine to build muscle (4x the recommended dose on the label). He also had been dabbling in some steroids. After a month or so on the big doses of creatine, he had some horrible cramping in his calves, went to the ER and was told he was just dehydrated. Gave him IVF, sent him home. He woke up next am with horrible cramping, couldn't walk. Went back to the ER, they drew some labs and sent him immediately over to my hospital--he had rhabdo so bad his quads, calves, biceps/triceps hamstrings and abd muscles were necrotic. They had to remove almost all of his quads and calf muscles, I&D'd everything several times over, and now he is a shell of his former self. Somehow he is able to stand and walk very short distances. The remaining quad muscles contracted so his knees are locked fairly straight, but this kid was only 20 years old and managed to ruin his life. Somehow his kidneys survived the ordeal, and most of his problems are musculoskeletal in nature (and emotional). His CK while he was in ICU was over 32,000. Unbelievable.

purplemania, BSN, RN · Aug 16, 2004

my 79 y/o father contracted this last summer. He was on 2 statin drugs, guafenisen, advil and another drug (don't recall), all of which are metabolized thru the liver. He was hospitalized for a week, and barely escaped dialysis. Afterwards, when his dr wanted to resume some of those meds, Dad refused. He said he was going to die "soon" anyway, and did not want to be that sick again. He is not as afraid of an MI as he is rhabdo.

chris_at_lucas_RN, RN · Aug 17, 2004

We had a kid who was a bodybuilder, taking lots of creatine to build muscle (4x the recommended dose on the label). He also had been dabbling in some steroids. After a month or so on the big doses of creatine ... he had rhabdo so bad his quads, calves, biceps/triceps hamstrings and abd muscles were necrotic. They had to remove almost all of his quads and calf muscles, I&D'd everything several times over, and now he is a shell of his former self. Somehow he is able to stand and walk very short distances. The remaining quad muscles contracted so his knees are locked fairly straight, but this kid was only 20 years old and managed to ruin his life. Somehow his kidneys survived the ordeal, and most of his problems are musculoskeletal in nature (and emotional). His CK while he was in ICU was over 32,000. Unbelievable.

Lucky to be alive, sounds like. Hope his discharge plan included referral for individual psychotherapy.

blue280 · Aug 17, 2004

Good timing on this thread! I had a pt yesterday with compartment syndrome of both calves. She was in the unit for a week, dx with rhabdo, 3bouts of dialysis. Labs are looking much better now. Big pain control issues! She has 2 facsiotomies on both legs, I never saw wounds like that! problem is, she has been in for opiate toxcitity in June and now her MD's are leery of prescribing too much for pain. Even with the facsiotomies she has, her legs are still very edamatous and she cries during dressing changes (which are Q4hrs) She has a fentynyl patch 75mcg and get oxycontin SR 20mg Q12hr. Any suggestions?

KRVRN, BSN, RN · Aug 18, 2004

How did Creatine cause all those muscles to become necrotic?

Fgr8Out · Aug 18, 2004

Good timing on this thread! I had a pt yesterday with compartment syndrome of both calves. She was in the unit for a week, dx with rhabdo, 3bouts of dialysis. Labs are looking much better now. Big pain control issues! She has 2 facsiotomies on both legs, I never saw wounds like that! problem is, she has been in for opiate toxcitity in June and now her MD's are leery of prescribing too much for pain. Even with the facsiotomies she has, her legs are still very edamatous and she cries during dressing changes (which are Q4hrs) She has a fentynyl patch 75mcg and get oxycontin SR 20mg Q12hr. Any suggestions?

So long as she's not oversedated, her physician should look at increasing her pain medication and provide something IV for dressing changes and/or a shorter acting analgesic possibly every 4 hours as needed. For wounds of that magnitude, the medications ordered are definitely inadequate, judging by the patient's response.