Rhabdomyolyse

In Medicine, the rhabdomyolyse indicates the destruction of muscular cells.

Etiology

The typical cases are:

the muscular traumatism involving a crushing.
the Anoxia prolonged, for example following a compression of part of the body: Garrot, burial (one speaks then about the Syndrome of Bywaters , of the syndrome of buried the or crush syndrome ).
the Ischaemia: occlusion of an artery with muscular destiny resulting in death ( necroses ) not irrigated fabrics.
the Toxic catch of S (Cocaine)
Drug them (statines, fibrates, succinylcholine).
the electrification (passage of Electric current in the body);
certain physical efforts violent ones and prolonged when it are practiced without adequate preparation (marathon, extreme triathlon, musculation…)
consumption of mushroom Tricholoma auratum or equestrian Tricholome (alias Knight, Gold coin, Bidaou), however considered edible. The rhabdomyolyse occurs here in way proportions dependant. A repeated consumption possibly being able to result in death.

Diagnosis

Salting out in the blood of muscular enzymes, in particular the Creatin phospho kinase (or CPK) and the Myoglobine makes it possible to confirm the rhabdomyolyse. A proportioning of Créatine phospho kinase higher than 5000 UI/l is the witness of a massive rhabdomyolyse. the rate of normal CPK lies between 25 & 190 U/l.

At the time of the destruction of a muscle, there is myoglobin release which will be filtered by the kidneys. However, the myoglobin is toxic for the renal Tubules because it precipitates what has for conséquense to involve an acute impaired renal function.

The passage of the Myoglobine in the urines gives them a red-brown coloring, from where the name which to them is classically given urines " porto".

Complications

If it is massive, the destruction of the cells releases from the Potassium in the Sang; this Hyperkaliémie can involve Troubles cardiac rhythm even the cardiac arrest if the Kaliémie is really high. That also releases from the Toxine S which can involve the Mort in the short run.

Salting out in the blood of muscular enzymes can cause a Impaired renal function by a badly known mechanism: historically, it was thought that the Myoglobine came to injure the Rein in precipitant in the renal Tubule, but of the recent studies would be more in favor of a Oxydation of the cellular membranes of the tubules by the released Toxine S.

Treatment

Rehydration by Perfusion.
alkaline Diuresis (Perfusion by bicarbonate of sodium).
Protecteurs of the renal Oxydation (N-acétylcystéine)
Dialyze if Impaired renal function severe

Bonds

Rhabdomyolysis, J Am Plowshare Nephrol 11:1553 - 1561, 2000

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