RHABDOMYOLYSIS
1999; Elsevier BV; Volume: 15; Issue: 2 Linguagem: Inglês
10.1016/s0749-0704(05)70061-0
ISSN1557-8232
Autores Tópico(s)Electrolyte and hormonal disorders
ResumoThe somatic muscle that constitutes approximately 40% of total body weight is subject to a variety of environmental, metabolic, and infectious injuries. Dissolution of sarcolemma of muscle and release of potentially toxic intracellular components into the systemic circulation and the attendant consequences constitute the syndrome of rhabdomyolysis. This syndrome appears to have been recognized since antiquity, being referenced indirectly in the Holy Bible. 46 Numbers, 11:31–35 Google Scholar In modern times, however, it was not until the classic observations of Bywaters and Beall 3 Bywaters E.G.L. Beall D. Crush injuries with impairment of renal function. BMJ. 1941; 1: 427-432 Crossref PubMed Scopus (545) Google Scholar on the victims of the bombing raids in London during World War II that the clinical consequences of crush syndrome were fully appreciated. A plethora of nontraumatic causes of rhabdomyolysis are recognized now. 13 Gabow P.A. Keahney W.D. Kelleher S.P. The spectrum of rhabdomyolysis. Medicine. 1982; 61: 141-152 Crossref PubMed Scopus (758) Google Scholar Although many organ systems are involved in rhabdomyolysis, life-threatening electrolyte abnormalities, i.e., acute hyperkalemia, hypocalcemia, and acute renal failure, are the predominant consequences of rhabdomyolysis. The hypocalcemia may further accentuate the cardiac toxicity of hyperkalemia, which may complicate rhabdomyolysis. Acute metabolic acidosis is another complication of rhabdomyolysis; this acidosis results from the release of intracellular phosphate and sulfate. It has been now estimated that approximately one third of the patients with rhabdomyolysis develop acute renal failure 13 Gabow P.A. Keahney W.D. Kelleher S.P. The spectrum of rhabdomyolysis. Medicine. 1982; 61: 141-152 Crossref PubMed Scopus (758) Google Scholar and that this condition accounts for approximately 10% to 15% of acute renal failure in hospitalized patients in the United States. 50 Zager R.A. Rhabdomyolysis and myohemogobinuric acute renal failure. Kidney Int. 1996; 49: 314-326 Crossref PubMed Scopus (501) Google Scholar The somatic muscle that constitutes approximately 40% of total body weight is subject to a variety of environmental, metabolic, and infectious injuries. Dissolution of sarcolemma of muscle and release of potentially toxic intracellular components into the systemic circulation and the attendant consequences constitute the syndrome of rhabdomyolysis. This syndrome appears to have been recognized since antiquity, being referenced indirectly in the Holy Bible. 46 Numbers, 11:31–35 Google Scholar In modern times, however, it was not until the classic observations of Bywaters and Beall 3 Bywaters E.G.L. Beall D. Crush injuries with impairment of renal function. BMJ. 1941; 1: 427-432 Crossref PubMed Scopus (545) Google Scholar on the victims of the bombing raids in London during World War II that the clinical consequences of crush syndrome were fully appreciated. A plethora of nontraumatic causes of rhabdomyolysis are recognized now. 13 Gabow P.A. Keahney W.D. Kelleher S.P. The spectrum of rhabdomyolysis. Medicine. 1982; 61: 141-152 Crossref PubMed Scopus (758) Google Scholar Although many organ systems are involved in rhabdomyolysis, life-threatening electrolyte abnormalities, i.e., acute hyperkalemia, hypocalcemia, and acute renal failure, are the predominant consequences of rhabdomyolysis. The hypocalcemia may further accentuate the cardiac toxicity of hyperkalemia, which may complicate rhabdomyolysis. Acute metabolic acidosis is another complication of rhabdomyolysis; this acidosis results from the release of intracellular phosphate and sulfate. It has been now estimated that approximately one third of the patients with rhabdomyolysis develop acute renal failure 13 Gabow P.A. Keahney W.D. Kelleher S.P. The spectrum of rhabdomyolysis. Medicine. 1982; 61: 141-152 Crossref PubMed Scopus (758) Google Scholar and that this condition accounts for approximately 10% to 15% of acute renal failure in hospitalized patients in the United States. 50 Zager R.A. Rhabdomyolysis and myohemogobinuric acute renal failure. Kidney Int. 1996; 49: 314-326 Crossref PubMed Scopus (501) Google Scholar
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