Clinical manifestations of rhabdomyolysis

Rhabdomyolysis is a relatively serious disease. The most obvious symptom is decreased renal function and even acute renal failure. It can also cause metabolic disorders in the body. Patients often experience muscle pain, muscle weakness, and swelling. It can cause fever, a significant increase in white blood cells and neutrophils, and patients may experience anuria or oliguria, etc.

The clinical manifestations of rhabdomyolysis include muscle pain, tenderness, swelling, weakness and other muscle involvement, as well as fever, general fatigue, increased white blood cell and (or) neutrophil ratio and other inflammatory response manifestations. Urine appearance: brown or red wine-colored urine. About 30% of patients with this disease will develop acute renal failure. When the acute renal failure is severe, oliguria, anuria and other manifestations of azotemia may be seen.

diagnosis

1. Highly suspected (1) There is a typical medical history (including suspected etiology, muscle manifestations and urine color changes); (2) There is "blood" in the urine routine, but no red blood cells or a small number of red blood cells are found under microscopic examination; (3) Serum muscle enzymes are 5 times higher than the normal value, usually creatine kinase (CK)>10000U/L, lactate dehydrogenase is also elevated, but there is no obvious heart disease or isoenzymes are also elevated, indicating that it is of skeletal muscle origin. 2. Confirmation of the diagnosis depends on the determination of myoglobin in blood or urine. (1) Immunochemical method is the most sensitive. (2) Normal levels of radioimmunoassay: blood myoglobin is 3-80 ng/ml, and urine is 3-20 ng/ml. (3) If the urine myoglobin concentration is ≥250ug/ml (corresponding to approximately 100g of muscle damage), the urine color will change significantly. (4) In some cases, increased myoglobin in the blood or urine cannot be detected in time because myoglobin is released early after rhabdomyolysis and is cleared quickly when renal function is normal, which is subclinical rhabdomyolysis.

treat

1. Stabilize the patient's vital signs and pay attention to the monitoring of intake and output; 2. Remove the inducement of rhabdomyolysis; avoid risk factors that aggravate rhabdomyolysis. 3. Prevention of acute tubular necrosis: ① Volume resuscitation; ② Alkalinization of urine; ③ Use of antioxidants to protect tubular cells; ④ Hemodialysis or hemofiltration: If acute renal failure has occurred, renal replacement therapy may be required until renal function recovers. 4. Treatment of other complications.