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This results from skeletal muscle breakdown, with release of its contents into the circulation including myoglobin. potassium. phosphate urate and creatinine kinase (CK).

Complications include hyperkalemia and ARF:
  1. Causes:
    1. Trauma
    2. Prolonged immobilization
    3. burns,
    4. crush injury
    5. excessive exercise
    6. uncontrolled seizures;
  2. Drugs and toxins:
    1. statins,
    2. fibrates,
    3. alcohol,
    4. ecstasy,
    5. heroin,
    6. snake bite,
    7. carbon monoxide,
    8. neuroleptic malignant syndrome,
  3. Infections: Coxsackie. EBV. influenza; myositis, Malignant hyperpyrexia
  4. Inherited muscle disorders: Mc Adel’s disease. Duchenne’s muscular dystrophy.
Clinical features: Often of the cause, muscle weakness, pain, swelling tenderness and red brown urine non oliguric renal failure. (LQ 2012)

Tests: Blood tests show a raised CK. Dark urine is +ve for blood on dipstick but without RBCs on microscopy.
Confirmed by +ve urinary/serum myoglobin.
Others: Hyperkalemia, Hyperphosphatemia, Hyperuricemia, Hypocalcemia. (AIPG 10)
ARF occurs 12-24 hours later and DIC is associated
Compartment syndrome can result from muscle injury.


Important Points


  1. Urgent treatment for hyperkalemia.
  2. In dehydration fluid replacement is a priority to prevent ARF: maintain urine output at 300mUh until myoglobinuria has stopped (initially up to 1.5 lit may be needed).
  3. IV sodium bicarbonate is used to alkalinize urine to pH >6.5, to stabilize a less toxic form of myoglobin.
  4. Dialysis may be needed, full renal recovery is usually there.


Extra Edge


Causes of non oliguric renal failure: 

  1. Tubulointerstitial
  2. Partial obstructive nephropathy
  3. Radiocontrast-induced ARF
  4. Rhabdomyolysis
  5. Aminoglycoside
  6. Lithium
  7. Cisplatin

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