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Rhabdomyolysis: Complications

Rhabdomyolysis is a syndrome involving widespread muscle breakdown and necrosis following muscle injury with subsequent release of K+, CPK, myoglobin and other intramuscular components resulting in several complications including:

  • Electrolyte abnormalities
    • Hyperkalemia àrisk of cardiac arrhythmia and arrest
    • Hyperphosphatemia
    • Hypocalcemia à risk of conduction abnormalities and neurological complications (i.e. Seizures)
    • Hyperuricemiaàanion gap metabolic acidosis, gout and renal caculi
  • DIC à secondary to release of thromboplastin and other prothrombotic components from damaged muscle
  • Compartment Syndromeà especially after aggressive fluid resuscitation resulting in a fluid shift to the closed compartment of the initial muscle insult.
  • AKIà especially in the setting of hypovolemia, sepsis, acidosis, renal ischemia and myoglobin accumulation in renal tubules.
  • Hypovolemiaà secondary to third spacing following extracellular fluid influx into compartments containing damaged muscle

References

  1. Gawbow, P., Kaehny, W., & Kelleher, S. (1982). The spectrum of rhabdomyolysis. Medicine (Baltimore) , 61 (3), 141. PubMed Link
  2. Grossman, R., Hamilton, R., Morse, B., Penn, A., & Goldberg, M. (1974). Nontraumatic rhabdomyolysis and acute renal failure. New England Journal of Medicine , 291 (16), 807 PubMed Link