Rhabdomyolysis - Differential Diagnosis and Management Summary

Trauma:

 • Immobilization, Crush iniury, Compartment syndrome, Electrical injury

Exertional:

 • Hyperthermia/Heat exhaustion, Heat iniury, Heat stroke, Metabolic myopathies, Excess exertion/training, Seizures, Malignant hyperthermia, Neuroleptic malignant syndrome

Nontraumatic nonexertional:

 • Electrolytes, Toxins. Drugs (Statins), ETOH Infection (Viral- HIV, Influenza, TSS, Herpes, Coxsackie etc), Endocrine (Hypo/Hyperthyroidism), Autoimme (polymyositis/Dermatomyositis)

AKI - Pathophysiology:

 1.  Shift of extracellular fluid into injured muscles -> HYPOTENSION -> renal vasocontriction-> decreased renal renal ischemia

 2. Cast formation: Renal tubular obstruction

 3. Direct myoglobin nephrotoxicity

 4. Heme associated free radicals- oxidative iniury

Treatment:

 1. Prevent Prerenal azotemia: Isotonic saline

 2. Iinitial rate: 1-2 L/hour with goal urine output: 200ml/hr

 3. Monitor potassium and calcium several times per day until stable

 4. Loop diuretics for fluid overload

 5. Dialysis for severe hyperkalemia or ATN

 6. Allopurinol for hyperuricemia if levels > 8mg/dL



#Rhabdomyolysis #Differential #Diagnosis #Management #Summary #causes #treatment