The syndrome of rhabdomyolysis: Complications and treatment

Yiannis S. Chatzizisis, Gesthimani Misirli, Apostolos I. Hatzitolios, George D. Giannoglou

Research output: Contribution to journalReview article

136 Scopus citations

Abstract

Rhabdomyolysis is a syndrome of skeletal muscle cell damage that leads to the release of toxic intracellular material into the systemic circulation. The pathogenesis of rhabdomyolysis is based on an increase in free ionized calcium in the cytoplasm. Its main complications include (a) acute renal failure, which is triggered by renal vasoconstriction and ischemia, (b) myoglobin cast formation in the distal convoluted tubules, and (c) direct renal toxic effect of myoglobin on the epithelial cells of proximal convoluted tubules. Other major complications include electrolyte disorders, such as hyperkalemia, which may cause cardiac arrhythmias, metabolic acidosis, hyperphosphatemia, early hypocalcemia, and late hypercalcemia. Compartmental syndrome and disseminated intravascular coagulopathy may also emerge. The management of myoglobinuric acute renal failure includes aggressive fluid administration to restore the hypovolemia and urine alkalization. The concomitant electrolyte and metabolic disorders should also be treated appropriately; hemodialysis should be considered when life-threatening hyperkalemia and metabolic acidosis exist. In the case of compartmental syndrome, it is important to monitor the intra-compartmental pressure and to perform fasciotomy, if required. When diagnosed early and if the appropriate treatment is initiated promptly, the complications of rhabdomyolysis are preventable and the syndrome has a good prognosis.

Original languageEnglish (US)
Pages (from-to)568-574
Number of pages7
JournalEuropean Journal of Internal Medicine
Volume19
Issue number8
DOIs
StatePublished - Dec 2008

Keywords

  • Acute renal failure
  • Compartmental syndrome
  • Electrolyte disturbances
  • Metabolic acidosis
  • Rhabdomyolysis

ASJC Scopus subject areas

  • Internal Medicine

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