Non oliguric renal failure is seen in? (LQ)
This results from skeletal muscle breakdown, with release of its contents into the circulation including myoglobin. Potassium, phosphate, urate and creatinine kinase.
Complications include hyperkaliemia and ARF:
Causes of rhabdomyolysis :
1. i. Trauma. ii. Prolonged immobilization iii. burns, iv. crush injury v. excessive exercise vi. uncontrolled seizures;
2. Drugs and toxins: i. statins, ii. fibrates, iii. alcohol, iv. ecstasy, v. heroin, vi. snake bite, vii. carbon monoxide, viii. neuroleptic malignant syndrome ,
3. Infections: Coxsackie. EBV. influenza; myositis, Malignant hyperpyrexia
4. Inherited muscle disorders: McArdle’s disease. Duchenne’s muscular dystrophy.
Clinical features of rhabdomyolysis: Often of the cause, with muscle weakness of pain, swelling tenderness and red brown urine non oliguric renal failure.
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 06)
ARF occurs 12-24 hours later and DIC is associated
Compartment syndrome can result from muscle injury.
Extra Edge: Treatment:
1. Urgent treatment for hyperkaliemia.
2. In dehydration fluid replacement is a priority to prevent ARF: maintain urine output at 300ml/h 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.
Dialysis may be needed, full renal recovery is usually there.