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Mechanical trauma, burns, intoxication with alcohol or certain drugs, as well as infection with certain viruses can lead to the breakdown of muscle cells, i.e. rhabdomyolysis.
When muscle tissue breaks down, the components inside the muscle cells enter the bloodstream. The consequence of this is a significant increase in their concentration – mainly potassium and myoglobin – in the blood and high activity of intracellular enzymes, mainly AST, CK and LDH. The process of rhabdomyolysis can develop for many reasons. Most often they are external mechanical damage (the so-called crush syndrome) or thermal damage, i.e. extensive burns. Rhabdomyolysis can also occur with extreme physical exertion, electric shock, acute ischemia of large groups of muscles, the use of certain drugs (e.g. statins, cyclosporin A, theophylline), intoxication with drugs, alcohol or carbon monoxide, after an overdose of drugs such as cocaine, amphetamines or heroin. This process may begin after seizures or other causes, influenza or Epstein-Barr virus infections, bacterial infections, e.g. in the course of sepsis, electrolyte and metabolic disturbances, myopathy, and poisonous snake bites.
Mioglobiny
In the process of rhabdomyolysis, myoglobin is of key importance, as it has properties similar to hemoglobin, e.g. similar oxygen carrying capacity.
Myoglobin is a protein that is involved in the storage of oxygen. Its main task is to accumulate oxygen in red muscles, i.e. striated muscles. One myoglobin molecule carries one oxygen molecule. When the muscles are overstrained and lack oxygen, myoglobin releases it so that the muscles can work.
Myoglobin is filtered at the glomeruli from where it enters the renal tubules. In an extreme situation, e.g. as a result of an injury to the renal tubules, myoglobin forms conglomerates, leading to their obstruction, i.e. narrowing. The kidney vessels also contract, which may result in acute renal failure and the need for renal replacement therapy.
Rhabdomyolysis – The essence of the disease
Symptoms of rhabdomyolysis are dark (like weak coffee) urine and severe muscle pain. But not all trauma ends like this. In order to diagnose rhabdomyolysis, laboratory tests and determination of the level of creatine kinase activity are necessary.
The disease was first described during World War II after analyzing the health of the victims of the London bombing. Currently, it mainly concerns the victims of serious road accidents, catastrophes and people practicing competitive sports. In the case of athletes, men are more likely to suffer from rhabdomyolysis, which, scientists believe, is related to the greater muscle mass in men and the fact that the female body has more efficient heat management mechanisms.
Cases of rhabdomyolysis mainly affect marathon runners, cyclists, rugby players and weight lifters. But it is also exposed to those people who, after a long break, start a very intense amateur training or begin to exercise intensively after a viral infection.
Not every case of rhabdomyolysis is fatal. Many people who experience this disease recover unscathed after proper hydration and a solid rest.
Uwaga – statue new
Medicines from this group, mainly atorvastatin, can cause myopathy, i.e. a disease that manifests itself in severe pain, muscle weakness and hypersensitivity. Blood tests show that people taking statins show that blood creatine kinase levels are elevated, which is evidence of muscle damage. Improperly conducted, mainly with too high doses of drugs, treatment with statins may lead to muscle breakdown, and thus threaten the patient’s life, because it is associated with the risk of acute renal failure.
Rhabdomyolysis – Treatment
As with many other conditions, therapy depends on the patient’s condition and symptoms. If the disease is caused by taking medications, they should be discontinued and the patient should be rehydrated intravenously to ensure proper diuresis. It is also necessary to constantly monitor the work of the kidneys and the level of potassium, phosphorus and uric acid. In some severe cases of rhabdomyolysis, renal replacement therapy, i.e. dialysis, is necessary.
Tekst: Anna Jarosz