1Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Rhabdomyolysis is a rare and complex condition, which is caused by the breakdown of striated muscle fibre. The breakdown of muscle tissue causes the release of intracellular components into the bloodstream. The causes of rhabdomyolysis are diverse, although all share the same pathophysiological mechanism – the essential element is the destruction of sarcolemmic membrane, consequently causing accumulation of creatine kinase and myoglobin in the circulation. The clinical presentation of rhabdomyolysis varies from asymptomatic increase in serum levels of enzymes released from damaged muscles or the classic triad of symptoms including muscle pain, weakness and dark-tea coloured urine to severe cases with volume depletion, metabolic acidosis, electrolyte abnormalities and acute kidney injury. The diagnosis is based on elevated serum creatinine kinase level above 1000 U/l or at least 5 times the upper limit of normal. Other diagnostic tests, which are necessary to perform include serum myoglobin, urinalysis, and a full metabolic panel with serum creatinine and electrolytes. Effective and accurate diagnosis leads to timely and appropriate treatment. The spectrum of treatment includes removing the cause of muscle destruction, early intravenous crystalloid solution infusion and standard correction of electrolyte disbalances. Also, mannitol, loop diuretics and bicarbonate infusion are used for treatment, yet they lack of evidence in literature. The prognosis of rhabdomyolysis is favourable, when diagnosed early and treated aggressively.
Keywords: rhabdomyolysis, muscle injury, myopathy, creatine kinase, acute kidney injury.