The Etiology, Pathophysiology, Diagnosis, And Possible Complications Of Rhabdomyolysis Essay
The Etiology, Pathophysiology, Diagnosis, And Possible Complications Of Rhabdomyolysis Essay
Introduction
Rhabdomyolysis refers to muscle injury and breakdown that leads to the accumulation of toxic substances in the bloodstream. These substance cause systemic effects such as electrolyte imbalances, acute renal injury, and disseminated intravascular coagulation (DIC), which then causes the symptoms such as myalgia, general weakness, anorexia, and dark-colored urine. In this paper, the author explains the etiology, pathophysiology, diagnosis, and possible complications of rhabdomyolysis The Etiology, Pathophysiology, Diagnosis, And Possible Complications Of Rhabdomyolysis Essay.
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Confirming the diagnosis of Rhabdomyolysis
Acute rhabdomyolysis results in elevated blood levels of creatinine kinase (CK), which is a muscle protein released from muscle breakdown. The diagnosis requires thorough history, clinical examination, and laboratory tests for CK, inflammatory markers and complete blood counts. The patient had blood tests done that revealed marked elevations in creatinine kinase levels in blood, her values were 118342 U/L (normal is 38-176 U/L). This was more than five times the normal values thus it is pathognomic for rhabdomyolysis. The detection of myoglobin in blood or urine would confirm the diagnosis. However, myoglobin is rapidly cleared from the system by the kidneys, so it is inferior to creatinine kinase in diagnosing rhabdomyolysis. A muscle biopsy could show the possible etiology of rhabdomyolysis but has no role in the diagnosis (O’Carroll & Fenwick, 2020). Therefore, high blood creatinine kinase, together with the patient’s clinical presentations is diagnostic for rhabdomyolysis and no additional tests are required.
The most likely etiology for the patient’s recurrent rhabdomyolysis
Rhabdomyolysis can sometimes occur in prolonged or strenuous exercise, infections, or trauma. However, the patient reveals no positive history of foreign travel trauma, exercise, or rash. She is not currently on any prescription medications. With other causes ruled out, the other likely etiologies for recurrent rhabdomyolysis are congenital muscle disorders and metabolic disorders affecting glycogen metabolism and fatty acid oxidation pathways (Ivin et al., 2019). In this patient, the most likely etiology is a metabolic disorder such as glycogen storage disease (McArdle disease), Carnitine palmitoyl transferase II, or mitochondrial myopathy The Etiology, Pathophysiology, Diagnosis, And Possible Complications Of Rhabdomyolysis Essay.
Pathophysiology and Complications of Rhabdomyolysis
The most common causes of muscle injury leading to rhabdomyolysis are overexertion, traumatic injuries, hypoxia, infections, drugs, and genetic disorders. The resultant effect of the insulting agent is muscle damage, which in turn may lead to ATP depletion within the muscle fibers or a direct injury to the sarcolemma. Since ATP is required for intracellular calcium regulation, its depletion impairs this regulation resulting in an increase in calcium levels within the muscle cells. This leads to persistent muscle contractions and energy depletion (Stanley et al., 2022). There is also a resultant activation of phospholipases and subsequent destruction of membrane proteins and fiber contents, releasing muscle proteins like creatinine kinase into the bloodstream. This is responsible for the symptoms of myalgia, myoglobinuria, and weakness.
The complications of rhabdomyolysis arise from the release of substances such as myoglobin into the circulation and electrolyte imbalances. These cause possible complications such as acute renal injury and failure, cardiac arrhythmias, and disseminated intravascular coagulation (O’Carroll & Fenwick, 2020).
Medications that may cause rhabdomyolysis
Rhabdomyolysis may occur as an adverse drug reaction to certain drugs that cause severe muscle injury. Some of the documented drugs that cause rhabdomyolysis include statins, trabectedin, Leflunomide, salicylates, amphotericin B, and propofol (Wen et al., 2019).
A 28-year-old woman was admitted to the general internal medicine service with a 3-day history of malaise and cough that progressed to include myalgia, generalized weakness, and dark-colored urine. Three days before admission, she had an abrupt onset of a dry nonproductive cough, malaise, and anorexia that resulted in a prolonged period of fasting. On the second day of the illness, she awoke with diffuse muscle pain and progressive weakness, culminating in an inability to walk. She subsequently noted dark urine and presented to the emergency department, leading to this admission. She had no recent trauma, exercise, rash, joint pain, or foreign travel. She was taking a multivitamin supplement but no prescription medication.
At presentation, she was mildly distressed but oriented. Her vital signs were within normal limits, apart from mild tachycardia (heart rate, 104 beats/min). Physical examination revealed grade 3/5 limb muscle strength, although testing was associated with obvious discomfort. Muscle bulk and tone, tendon reflexes, and sensation were normal. Notably, there was no rash, and cardiorespiratory examination yielded unremarkable findings. Initial chest radiography revealed a left lower lobe infiltrate most consistent with pneumonia. Urinalysis was strongly positive for hemoglobin. Initial laboratory analysis (reference ranges provided parenthetically) revealed that her creatine kinase (CK) level was markedly elevated at 118,342 U/L (38-176 U/L)The Etiology, Pathophysiology, Diagnosis, And Possible Complications Of Rhabdomyolysis Essay.
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1. What is the most appropriate next step to confirm the diagnosis of rhabdomyolysis in this patient? Provide an explanation for your answer.
2. What is the most likely etiology of this patient’s recurrent rhabdomyolysis?
3. Rhabdomyolysis is a rapid breakdown of muscle. Detail the pathophysiology behind rhabdomyolysis.
4. What are the possible complications of rhabdomyolysis?
5. Which medications may cause rhabdomyolysis?
References
Ivin, N., Della Torre, V., Sanders, F., & Youngman, M. (2019). Rhabdomyolysis caused by carnitine palmitoyltransferase 2 deficiency: A case report and systematic review of the literature. Journal of the Intensive Care Society, 21(2), 165-173. https://doi.org/10.1177/1751143719889766
O’Carroll, C., & Fenwick, R. (2020). Rhabdomyolysis: A case-based critical reflection on its causes and diagnosis. Emergency Nurse, 28(3), 24-28. https://doi.org/10.7748/en.2020.e2004
Stanley M., Chippa V., Aeddula, N. R., & Adigun R. (2022). Rhabdomyolysis. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK448168/
Wen, Z., Liang, Y., Hao, Y., Delavan, B., Huang, R., Mikailov, M., Tong, W., Li, M., & Liu, Z. (2019). Drug-induced Rhabdomyolysis atlas (DIRA) for idiosyncratic adverse drug reaction management. Drug Discovery Today, 24(1), 9-15. https://doi.org/10.1016/j.drudis.2018.06.006 The Etiology, Pathophysiology, Diagnosis, And Possible Complications Of Rhabdomyolysis Essay