Complications
Rhabdomyolysis is responsible for approximately 10% of AKI cases.[1][5]
The development of AKI is thought to be multifactorial. Muscle injury results in the release of myoglobin, uric acid, and myocyte cytosol contents into the plasma. Pigmented casts form in renal tubules, which is thought to result in obstruction,[5] and direct toxicity to tubules is thought to occur through the heme components of myoglobin. Renal ischemia occurs as a result of vasoconstriction of the renal arterioles in an underperfused state.
Treatment is directed at hydration methods to provide aggressive diuresis.[33] This may include alkalinization of the urine and use of diuretic therapy.
Hyperkalemia is the most lethal electrolyte abnormality, as it can cause ventricular arrhythmias.
Hypocalcemia is an early feature and is thought to be caused by deposition of calcium in damaged muscle tissue. Calcium supplementation is not recommended, however, as its use in a high phosphate state may cause soft tissue deposition.
Phosphorus and magnesium levels should be monitored as both may be elevated due to leakage from the disrupted myocytes.
Severe electrolyte abnormalities with associated metabolic acidosis require emergency hemodialysis.
Compartment syndromes may be the cause of rhabdomyolysis (traumatic "crush" injury) or develop as a result of medical conditions causing limb compression from immobilization.
It is a self-sustaining state due to ongoing vascular occlusion, tissue ischemia, and resultant edema.
Monitoring of intramuscular tissue compartments using the wick-catheter technique helps guide the surgical decisions for fasciotomy.
DIC may develop as a result of extensive myonecrosis with release of activating substances from injured muscle cells.
Fresh frozen plasma and/or platelet transfusions may be required.
Multisystem failure including pulmonary and hepatic dysfunction may occur with severe cases of rhabdomyolysis.
LFTs are monitored for evidence of hepatic insufficiency. Ventilator assistance may be necessary if pulmonary capabilities are compromised.
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