Please use this identifier to cite or link to this item: http://hdl.handle.net/20.500.12857/118919
Title: Non-traumatic rhabdomyolysis: Background, laboratory features, and acute clinical management
Authors: Cervellin, Gianfranco 
Comelli, Ivan
Benatti, Mario
Sanchis-Gomar, Fabian
Bassi, Antonella 
Lippi, Giuseppe 
Keywords: Creatine kinase;Crush syndrome;Myoglobin;Myopathy;Rhabdomyolysis
Keywords Plus: ACUTE KIDNEY INJURY;ACUTE-RENAL-FAILURE;COCAINE-ASSOCIATED RHABDOMYOLYSIS;EXERTIONAL RHABDOMYOLYSIS;EMERGENCY-DEPARTMENT;AFRICANIZED BEES;INDUCED MYOPATHY;CREATINE-KINASE;LIPOCALIN NGAL;RISK-FACTORS
Mesh headings: Acute Kidney Injury;Fluid Therapy;Myalgia;Prescription Drugs;Rhabdomyolysis;Sodium Bicarbonate
Secondary Mesh headings: Biomarkers;Creatine Kinase;Disease Management;Emergency Service, Hospital;Humans;Muscle, Skeletal;Myoglobin
Issue Date: Aug-2017
Publisher: PERGAMON-ELSEVIER SCIENCE LTD
Journal: Clinical biochemistry 
Abstract: 
Rhabdomyolysis is a relatively rare condition, but its clinical consequences are frequently dramatic in terms of both morbidity and mortality. Although no consensus has been reached so far about the precise definition of this condition, the term rhabdomyolysis describes a rapid breakdown of striated, or skeletal, muscle. It is hence characterized by the rupture and necrosis of muscle fibers, resulting in release of cell degradation products and intracellular elements within the bloodstream and extracellular space. Notably, the percentage of patients with rhabdomyolysis who develop acute kidney injury, the most dramatic consequence, varies from 13% to over 50% according to both the cause and the clinical and organizational setting where they are diagnosed. Despite direct muscle injury (i.e., traumatic rhabdomyolysis) remains the most common cause, additional causes, frequently overlapping, include hypoxic, physical, chemical or biological factors. The conventional triad of symptoms includes muscle pain, weakness and dark urine. The laboratory diagnosis is essentially based on the measurement of biomarkers of muscle injury, being creatine kinase (CK) the biochemical "gold standard" for diagnosis, and myoglobin the "gold standard" for prognostication, especially in patients with non-traumatic rhabdomyolysis. The essential clinical management in the emergency department is based on a targeted intervention to manage the underlying cause, combined with infusion of fluids and eventually sodium bicarbonate. We will present and discuss in this article the pathophysiological and clinical features of non-traumatic rhabdomyolysis, focusing specifically on Emergency Department (ED) management.
URI: http://hdl.handle.net/20.500.12857/118919
ISSN: 00099120
DOI: 10.1016/j.clinbiochem.2017.02.016
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