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Patient Profiles
L.T., an 82-year-old widow, was removing a chicken from the oven when she slipped backward onto the open oven door, sustaining deep burns to her buttocks. Mrs T. then tumbled forward, landed in the roasting pan, and seared her chest as well. Unable to move, she lay on the floor for 2 days until found by her daughter. Upon arrival at the hospital, Mrs T. was badly burned, was dehydrated, and had a potassium level of 79 mmol/L (7.9 mEq/dL).
While scaling a razor wire fence in an attempt to flee the police, 34-year-old S.G. fell 2.4 m (8 ft) to the pavement. When paramedics arrived, they noted that he was extremely tremulous, covered with lacerations, and had 4+ nystagmus. His level of consciousness was significantly altered. Electrocardiography in the emergency department revealed tall, peaked T waves. he had a rectal temperature of 41.2°C (106.1°F), and the toxicological screen of his urine was positive for cocaine. Twelve hours after admission, compartment syndrome of the right forearm developed.
R.K., a 55-year-old man, was installing a large television antenna on his roof when the antenna fell backward, contacting both R.K.'s head and a power line behind the house. After inflicting deep electrical injuries to his scalp and right hand, the energy traveled through R.K.'s body and exited by blowing off his right foot. he was having seizures when found by his wife, and he was unconscious when he arrived at the trauma center. After insertion of a urinary catheter, a small amount of thick, black urine drained.
Despite their highly varied histories, profound rhabdomyolysis developed in each of the critically ill patients described in the "Patient Profiles" (see box). What is rhabdomyolysis? Why does it occur in such dissimilar populations? Which patients are at risk? What are the signs and symptoms? And how is it treated?
Definition
Myo refers to muscle, rhabdo means striated (as in striated or skeletal muscle), and lysis is breakdown. Therefore, rhabdomyolysis (pronounced rab'-do-mi-ol'-i-sis)1 is a dissolution of skeletal muscles that produces a nonspecific clinical syndrome that causes extravasation of toxic intracellular contents from the myocytes into the circulatory system. Regardless of the initial precipitating factor, leaky skeletal muscle cells constitute the common rhabdomyolysis pathway.2-6
Although somatic muscles account for...