RHABDOMYOLYSIS AND KIDNEY DAMAGE
Fig-1
To have a clear look please click on the figure
To have a clear look please click on the figure
Rhabdomyolysis is a rare but potentially life-threatening disease resulting from the disintegration of skeletal muscle cells (myocytes) with the leakage of toxic muscle cell contents into the extracellular space and blood circulation.
The major causes for this condition are direct muscle injuries by accidents, chronic myalgia, myopathies and indirect muscle injuries by immobilization in a place for a long time during a flight journey, or in a car, overexertion, heavy exercises, and drug abuse like HMG Co-A Reductase Inhibitors (...statins), narcotics, sleeping medicines, antihistamines, anticholinergics, amphetamine, alcohol and cocaine.
Narcotics and sedatives like sleeping pills cause indirect heavy pressure into the striated muscles to cause muscle damages.
Common OTC antihistamines such as doxylamine and diphenhydramine are available freely at the pharmacy counters. Prolonged use can cause myopathies.
Diet supplements or weight loss supplements that contain creatine and ephedra a plant that contains non-selective adrenergic agonist ephedrine (Anticholinergic) can cause this deadly disease.
Anticholinergics, antihistamines anxiolytics and sedatives cause heavy pressure on the striated skeletal muscles in the body in some parts or as a whole that may lead to muscle fibre damages.
Prolonged use of statins like simvastatin and rosuvastatin can cause rhabdomyolysis, especially with low serum vitamin D (<10ng/ml). Anybody take statin medicines for a long time must include vitamin -D in their prescription.
Heatstroke and overexertion cause muscular cell damages that lead to rhabdo.
Hypothermia in which the body temperature drop can produce many complications such as cardiovascular and neuronal defects that may exert heavy injury in the skeletal muscles. Avoid prolonged exposure of your body in extremely cold weather, and do not immerse your body in ice-cold water for a long time.
Viral and bacterial blood infections that are injurious to your muscle fibres.
Electrolytes such as potassium and calcium irregularities.
Hypothyroidism and hyperthyroidism
Kidney disorders elevate myoglobin in the blood.
Surgery that causes prolonged bed rest and immobilization that causes skeletal muscle disintegration.
Sickle cell anaemia
prolonged muscle inflammations.
Among all the above-mentioned causes for rhabdomyolysis, some are non-traumatic drug-induced indirect skeletal muscle injuries.
In rhabdomyolysis, there are elevations of serum myoglobin and creatine phosphokinase (CPK) in the blood followed by myoglobinuria in the urine.
Elevated CK cause hypotension and low blood supply to various organs like the kidney and the liver that leads to multiple organ failure.
Elevated CK also causes Compartment Syndrome.
SUMMARY OF CAUSES IN BRIEF
1.Muscle injury by accidents
2.Pressure on the muscles due to long time immobilization such as prolonged bed rest, long journey, coma.
3.Abusive drugs, such as narcotics, sedatives, antipsychotics, and antidepressants.
4.Prolonged and untreated burn injures.
5.Vitamin -D deficiency
6.Prolonged untreated microbial infections, skin cancers, psoriasis which damage skeletal muscles can precipitate rhabdomyolysis.
7.Prolonged body exposure to ultraviolet rays, harmful chemicals can cause rhabdomyolysis.
8.Overdosage and prolonged use of ...statin drugs like simvastatin, atorvastatin and pravastatin.
If you have acute or chronic pain in your lower back or neck and you are using narcotics, sedatives such as sleeping pills or any other psycho drugs and passing urine by dark red or brown colour, that confirms rhabdomyolysis. (See Fig.2)
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| Fig-2 |
Blood Profile in Rhabdo
1.Elevated muscle enzymes such as creatine phosphokinase (CPK), SGOT, SGPT, and LDH.
CPK level rise in the blood above 1000 U/L. That is 5 times the upper limit normally indicate rhabdomyolysis.
Myoglobin level exceeds 1.5mg/dl
Too much intake of protein with heavy exercise may elevate CPK level in the blood.
Urine Profile in Rhabdo
Colour = Dark Pinkish Red or Dark Brown
Creatine Phosphokinase (CPK) = Above 1000U/L
Myoglobin = even traces in the urine can indicate the presence of rhabdo but the colour of the urine changes to dark red or brown when myoglobin exceeds above 100gm/dl.
Any kind of muscular abuse can result in myalgia, myositis and rhabdomyolysis. These abuses are traumatic, or by drug overuses or by infections.
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| Fig-3 |
All antipsychotics including sleeping medicines, anticholinergics, antihistamines, are prone to abuse your muscles.
Symptoms of Rhabdo:
1.Muscle pain in the shoulders, thighs, or lower back.
2.Muscle weakness
3.Trouble moving arms and legs
4.Dark brown or red urine.
5.Decreased urination.
6.Abdominal pain
7.Nausea, vomiting
8.Fever, hyperthermia
9.Tachyarrhythmia
10.Confusion, and dehydration.
Sleeping Medicines That Causes Indirect Non-Traumatic Skeletal Muscle Injuries:
1.Alprazolam
2.Diazepam
3.Clonazepam
4.Lorazepam
and many other benzodiazepines.
5.Barbiturates
6.Opioids like heroin, morphine, codeine.
7.Abusive narcotics like cocaine, heroin, LSD, ketamine
8.Alcohol
Diagnosis:-
The most reliable diagnostic test for rhabdomyolysis is the elevated level of creatine phosphokinase(CPK) in the blood that is above 1000mg/dl.
This followed by a myoglobin test in the urine (dark pink coloured) test that confirms rhabdo.
Rhabdo-Treatments at Home:
The following home remedies can be beneficial when the disease is at the beginning stage.
1.Rest and relax conveniently so that muscle can recover from the damage.
2.Take plenty of water, light broth and sports drink to rehydrate your body and to prevent further kidney damages.
3.Withdraw abusive drugs such as sleeping pills step by step under the doctor's supervision.
4.Completely stop taking...statin like cholesterol-lowering drugs.
5.Stop performing hard and heavy exercises.
6. If you feel tired recline in comfort and relax.
Compartment Syndrome
Fig-4
Lower Extremity Compartment Syndrome
Lower Extremity Compartment Syndrome
Severe rhabdomyolysis at the extreme stage that may develop after fluid resuscitation produces potential complication like Compartment Syndrome.
Our body skeleton and skeletal muscles are divided into many compartments which are covered and separated by a special thick membrane known as Fascia.
Every compartment is supplied with muscle fibre cells, extra and intracellular fluids and components, neuronal and supplies. Any injuries to the myocytes, directly and indirectly, will disturb this system in a compartment, causes fluid collection inflammation and oedema in that compartment will lead to rhabdomyolysis.
Complications of Rhabdomyolysis:
1.Increased blood clotting
2.Low Pressure
3.Shock
4.Kidney and liver failure due to necrosis and insufficient blood supply.
5.Electrolytic imbalance.
6.Hypoalbuminemia (Blood albumin depletion)
7.Hyperuricemia (Increased uric acid level in the blood)
8.Compartment Syndrome
9.Disseminated Intravascular Coagulation. (DIC)
Disseminated Intravascular Coagulation. (DIC)
DIC is a condition affecting the blood's ability to coagulate to stop bleeding.
In DIC abnormal thick clots form inside blood vessels that consume all clotting factors of the blood. The depletion of the clotting factors causes heavy bleeding in all sites of the body.
The major causes of DIC are inflammations, infections, cancers and rhabdomyolysis.
Medical Counselling To Prevent Rhabdo
1. Avoid continuous use of statins and use them at one or two months interval.
2.Systematically withdraw the use of benzodiazepines, barbiturates and any other anxiolytics and sleeping pills.
3.Withdraw step by step the use of any psych medicines like antipsychotics, antidepressants and narcotics like opioids, cocaine, and LSD and completely stop them.
4.Carefully handle antihistamines, anticholinergics, adrenergic agonists and any other ANS agonists or antagonists under the doctor's advice.
5.Avoid self medications.
6.Do not take anabolic steroid or any other steroid without a doctor's supervisions.
7.Avoid diet control supplements that contain harmful drugs like ephedrine.
8.Be alert when you are taking any hormone drug especially thyroid hormone, androgenic or contraceptive pill.
Non-Medical Counselling
1.Do not perform heavy exercises
2.Do not subject your body to exertion. Be care the job and recreational games that involves exertion, and heat exposure.
3.Drink more water to avoid dehydration before and after strenuous exercises so that your kidneys can eliminate any toxic myoglobin released by your muscle easily.
4.Avoid taking too many proteins and bodybuilders before and after heavy exercises as it may cause elevation of creatine kinase in the blood.
5.Do not sit or stand in one place for a long time.
Conclusively Rhabdo is a rare condition but life-threatening and can occur to anybody at any time without age difference in case if you abuse your body by any means.
