• Clinical science

Rhabdomyolysis and crush syndrome (Myorenal syndrome…)

Abstract

Rhabdomyolysis is the breakdown of skeletal muscle tissue caused by either traumatic or nontraumatic injury (e.g., seizures, ischemia, drug reactions). Traumatic rhabdomyolysis is often due to a crush injury resulting from a prolonged crushing force on skeletal muscle, for example, after being trapped under a collapsed building or following a car accident. Symptoms may be caused by an overabundance of intracellular substances (e.g., myoglobin, potassium, phosphate) following their release from destroyed muscle cells or by third spacing. Rhabdomyolysis classically presents with myalgia, generalized weakness, and darkened urine (myoglobinuria). Complications include acute kidney injury and crush syndrome, the systemic manifestation of traumatic rhabdomyolysis. Crush syndrome is also often associated with acute kidney injury; additionally, it typically presents with signs of volume depletion (hypovolemia, shock) and compartment syndrome of the affected extremity (usually the lower legs). Treatment is generally conservative and includes fluid resuscitation and correction of metabolic abnormalities. In the case of renal failure, dialysis may be indicated.

Definition

  • Rhabdomyolysis: breakdown of skeletal muscle tissue
  • Crush injury: localized injury to the skeletal muscle by a crushing force
  • Crush syndrome: systemic manifestation of crush injury

References:[1][2]

Etiology

Causes of rhabdomyolysis

References:[2][3]

Pathophysiology

References:[4][1]

Clinical features

Rhabdomyolysis

Crush syndrome

  • In addition to signs of rhabdomyolysis: Hypovolemia and shock

References:[2][4]

Diagnostics

References:[4][2][5]

Treatment

  • IV fluid administration
  • Monitor fluid output and electrolyte levels
  • Correct electrolyte imbalances; as necessary (see treatment of hypocalcemia and hyperkalemia)
  • In the case of renal failure: consider hemodialysis

References:[2][1][3]

  • 1. Centers for Disease Control and Prevention. Crush Injury and Crush Syndrome. https://www.acep.org/MobileArticle.aspx?id=46079&parentid=740. Updated June 1, 2009. Accessed February 5, 2017.
  • 2. Muscal E. Rhabdomyolysis. In: Jung LK. Rhabdomyolysis. New York, NY: WebMD. http://emedicine.medscape.com/article/1007814. Updated November 4, 2016. Accessed February 5, 2017.
  • 3. Vanholder R, Sever MS, Erek E, Lameire N. Rhabdomyolysis. J Am Soc Nephrol. 2000; 11(8): pp. 1553–1561. pmid: 10906171.
  • 4. Genthon A, Wilcox SR. Crush syndrome: a case report and review of the literature. J Emerg Med. 2014; 46(2): pp. 313–319. doi: 10.1016/j.jemermed.2013.08.052.
  • 5. Huerta-alardín AL, Varon J, Marik PE. Bench-to-bedside review: Rhabdomyolysis: an overview for clinicians. Crit Care. 2004; 9(2): pp. 158–169. doi: 10.1186/cc2978.
last updated 10/23/2018
{{uncollapseSections(['BTbzGG', 'Z2cZTb0', 'zTbrtG', 'ZgbZFG', '0gbeFG', 'bgbHFG', '1gb28G'])}}