Rhabdomyolysis is a direct or indirect injury to skeletal muscle. When muscle fibers die, they release substances that were originally left in muscle cells, such as potassium ions, uric acid, creatine kinase (CK) and myoglobin. These are potentially harmful substances, which will seriously affect renal function and heart rhythm and cause a series of physical problems. If not handled in time, this is a disease with a chance to die!
Rhabdomyolysis can occur in people of any age, and the incidence of rhabdomyolysis in adults is higher than that in children. So what can cause rhabdomyolysis? Of course, ear and muscle trauma and long-term compression are one of the most likely reasons. The medical profession has just begun to understand that this disease was caused by patients who were crushed in the Second World War. Therefore, car accidents and falling buildings have caused strong muscle extrusion and injury, which is likely to cause rhabdomyolysis. Some people lie flat on the hard floor because of drunkenness. Because of long-term fixed posture, their muscles are squeezed, which can also cause muscle injury and rhabdomyolysis. If a building collapses after the earthquake, some parts of the rescued survivors' bodies are crushed by heavy objects for a period of time, and rhabdomyolysis is also very likely. Also, if the black widow is held down by a heavy object for a long time in the first episode of The Avengers, it is unlikely that she will run and jump together to resist Hulk's attack, but she will be super weak because of rhabdomyolysis! In addition, in the case of electric shock and snake bite, you should be careful of the possibility of rhabdomyolysis. Some people suffer from "internal injuries" rather than trauma! For example, muscle overuse, people who have not done training suddenly do squats 100 times, are suddenly fined 300 times, or suddenly have a seizure for 30 minutes. Excessive use of muscles in this way will put people at risk of rhabdomyolysis. At this time, if the environment is hot and humid, it is not easy to sweat and dissipate heat, and the patient has heatstroke and high body temperature, the situation will be even worse.
Another large group of patients have no trauma or muscle overuse, but they have other metabolic problems, such as sepsis, ketoacidosis, alcoholism, taking heroin, cocaine, amphetamine and other drugs, and all have the opportunity to get rhabdomyolysis. Patients who died after taking drugs may be related to rhabdomyolysis. The symptoms of rhabdomyolysis can be local or affect the whole body. Patients often have shoulder, thigh and lower back muscle pain; Complaining about muscle weakness and inability to move hands and feet; And noticed that the urine color is very dark, like soy sauce, and the urine volume is also small. Some patients will also have abdominal pain, nausea and vomiting, fever, rapid heartbeat and other symptoms. Although we call these three typical symptoms of rhabdomyolysis "muscle pain, general weakness and dark urine", in fact, the clinical symptoms are very different, and less than half of patients have typical symptoms! So in addition to the symptoms of rhabdomyolysis, the information given by the patient is very important! For example, he received excessive retraining in the afternoon and went to the emergency room in the middle of the night; Or on a hot day, the patient runs for heatstroke; Drink until you are paralyzed on the road; Or be pressed underground for a long time by collapsed heavy objects. This information will remind doctors of the possibility of rhabdomyolysis. Blood tests can let doctors know the patient's renal function, the concentration of ions in the blood and the clotting time. Just now, we said that the substances released after muscle injury will have high values during examination, such as high potassium ions, high phosphorus ions and high uric acid in blood. Another very important value is creatine kinase -CK. CK value (creatine kinase) will rise 12 hour after muscle injury, and it will climb to the highest point within one or two days after muscle injury, and then it will drop every day, and it will be relieved after about three to five days. If the measured CK value in blood exceeds four to five times the upper limit, it is probably rhabdomyolysis, and even the CK value of rhabdomyolysis patients often exceeds the normal range of 100 times! In addition to diagnosis, we can also use CK value to understand the patient's condition. If the CK value of the patient does not decrease after two days, it means that the muscle may continue to be damaged and release more creatine kinase.
As mentioned earlier, creatine kinase (CK) and myoglobin are released after muscle decomposition. Can you take a blood test to detect myoglobin? Myoglobin has a short half-life, so the blood test is not accurate, but we can do a urine test to see the content of myoglobin in urine! If it rises, you should also suspect rhabdomyolysis!
As for imaging examination, it can provide little help, unless it is through magnetic resonance or computed tomography to find out the cause of muscle injury, or to trace the cause of epilepsy. If rhabdomyolysis is suspected, many times the doctor will arrange an electrocardiogram, because too high potassium ion will affect the heartbeat and should be dealt with immediately. Patients with rhabdomyolysis have different degrees of severity and can be asymptomatic, but after blood collection, muscle enzymes in the blood increase. But it will bring serious complications such as electrolyte imbalance, acute kidney injury and cardiac arrest. The myoglobin produced after a large number of muscle injuries and decomposition will exceed the body load. When it is excreted by the kidney, excessive myoglobin will get stuck in the renal tubule, causing ischemic damage to renal cells, thus causing acute renal injury and even acute renal failure. A large number of muscle cells are injured, and at the same time, many intracellular potassium ions are released, which increases the concentration of potassium ions in the blood and makes the heartbeat irregular or even stop.
Therefore, the timing is very important to treat rhabdomyolysis! Only by early detection and timely treatment can patients have a 100% chance of recovery. If the timing of medical intervention is not early enough, patients will have more sequelae. The first choice for treatment is infusion therapy. To put it bluntly, more liquid is poured into the patient's body, so that the patient's kidney can produce enough urine, thus eliminating a large amount of metabolic waste accumulated by the body. If the patient's condition is serious enough to acute renal failure, it is necessary to arrange emergency dialysis treatment, which is commonly called kidney washing, to help the patient eliminate waste and maintain electrolyte balance.
Of course, it is very important to find out the cause of rhabdomyolysis in patients. Whether it is drugs, heatstroke or severe trauma, patients have to face different levels. If it is cavity syndrome caused by infusion therapy, it is local muscle necrosis and local accumulated pressure is too large. Fasciotomy and decompression should be considered. If it is related to diabetes, thyroid problems or other drugs, it is also necessary to deal with metabolic problems in time. Finally, we appeal to all of you. Although it's great to get into exercise habits and keep in shape, please don't suddenly do excessive exercise that exceeds your own load, and pay attention to the environment when exercising, see if temperature and humidity make you feel too tired, and replenish enough water when exercising. In addition, if you have metabolic diseases, remember to ask a doctor to diagnose and monitor the situation. If your child has recurrent rhabdomyolysis, remember to look for muscle diseases or metabolic diseases.