Rhabdomyolysis causes: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Rhabdomyolysis}} | {{Rhabdomyolysis}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{VSKP}} | ||
==Overview== | ==Overview== | ||
The aetiological spectrum of rhabdomyolysis is extensive in many cases, multiple muscle insults are usually needed to produce rhabdomyolysis unless an underlying [[myopathy]] is present. The most common causes of rhabdomyolysis in adults are [[illicit drugs]], [[alcohol abuse]], [[medication]], [[myopathy|muscle diseases]], [[trauma]], [[neuroleptic malignant syndrome]] (NMS), [[seizures]] and [[immobility]], Whereas in paediatric patients, the most common causes are [[myositis|viral myositis]], [[trauma]], [[connective tissue disorders]], [[exercise]], and [[drug overdose]].<ref name="pmid19841484">Khan FY (2009) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19841484 Rhabdomyolysis: a review of the literature.] ''Neth J Med'' 67 (9):272-83. PMID: [https://pubmed.gov/19841484 19841484]</ref> | |||
==Causes== | ==Causes== | ||
=== | ===Life-Threatening Causes=== | ||
* | *[[Burns]] | ||
* | *[[Crush injury]] | ||
* | *[[Electrical injury]] | ||
*[[Exertional Heat stroke]] | |||
*[[Compartmental syndrome]] | |||
*[[Malignant hyperthermia]] | |||
*[[Neuroleptic malignant syndrome]] | |||
*[[Electrolyte abnormalities]] such as [[Hypokalemia]] | |||
=== | ===Common Causes=== | ||
*[[ | *[[Burns]] | ||
*[[ | *[[crush injury]] | ||
*Long-lasting muscle compression in [[Coma]] patients, under the influence of [[alcohol]], medication or [[illicit drugs]] | |||
*[[Electrical injury]] | |||
*[[Snake venom]] | |||
* | *[[Heat stroke]] | ||
*[[Seizures]] | |||
*[[ | |||
*[[ | |||
* [[ | |||
===Causes by | ===Causes by Pathophysiology=== | ||
{{familytree/start}} | |||
{{familytree | | | | | | | | | | B01 | | | | | |B01=Rhadomyolysis}} | |||
{{familytree | | | | | |,|-|-|-|-|^|-|-|-|-|-|.| }} | |||
{{familytree | | | | | C01 | | | | | | | | | C03 |C01=Traumatic or Muscle Compression|C03=Non - Traumatic}} | |||
{{familytree | | | | | |!| | | | | | |,|-|-|-|^|-|-|-|.|}} | |||
{{familytree | | | | | |!| | | | | | D01 | | | | | | D02|D01=Non-Traumatic<br>'''Exertional'''|D02=Non-Traumatic<br> '''Non-Exertional'''}} | |||
{{familytree | | | | | |!| | |,|-|-|-|^|-|-|-|.| | | |!|}} | |||
{{familytree | | | | | |!| | E01 | | | | | | E02 | | |!|E01=Non - Traumatic Exertional Rhadomyolysis in a '''Normal Muscle'''|E02=Non - Traumatic Exertional Rhadomyolysis in an '''Abnormal Muscle'''}} | |||
{{familytree | | | | | |!| | |!| | | | | | | |!| | | |!| | | | | | | | | | |}} | |||
{{familytree | | | | | |!| | |`|.| | | | | |,|'| | | |!| | | | | | | | | | |}} | |||
{{familytree | | | | | |!| | | |!| | | | | |!| | | | |!| | | | | | | | | | |}} | |||
{{familytree |boxstyle=text-align: left; | | | | | F01 | | F02 | | | F03 | | | | F04 | | | | | | | | | |F01=❑ [[Crush injury]]<br> ❑ [[Coma]]<br> ❑ [[Post ictal state]]<br> ❑ [[Post operative complications|Post - Operative Surgical trauma]]<br> ❑ [[Electrical Injury]]<br> ❑ [[Compartment Syndrome]]<br> ❑ [[Immobility|Immobilizaion]]|F02=❑ [[Hyperthermia|Exertional Heat Stroke]]<br> ❑ [[Sickle cell trait]]<br> ❑ [[Hyperkinetic States]] Such as<br>* [[Grand mal Seizures]]<br> * [[Delirium tremens]]<br> * [[Psychosis|Psychotic agitation]]<br> * [[Amphetamine|Amphetamine Overdose]]|F03=❑ [[Myopathy|Metabolic myopathies]]<br> ❑ [[Myopathy|Mitochondrial myopathies]]<br> ❑ [[Malignant hyperthermia]]<br> ❑ [[Neuroleptic malignant syndrome]]|F04=❑ Drugs and toxins<br> ❑ [[Infections]]<br> ❑ [[Electrolyte abnormalities]]<br> ❑ [[Endocrinology|Endocrinopathies]]<br> ❑ [[Polymyositis|Inflammatory myopathies]]<br> ❑ Miscellaneous}} | |||
{{familytree/end}} | |||
{| | {| class="wikitable" | ||
! colspan="4" |Non-Traumatic Exertional Rhabdomyolysis in an Abnormal Muscle | |||
|- | |- | ||
| | ! style="width: 30%;" | '''Metabolic myopathies''' | ||
| | ! style="width: 30%;" | '''Mitochondrial myopathies''' | ||
! style="width: 20%;" | '''Malignant hyperthermia''' | |||
! style="width: 20%;" | '''Neuroleptic malignant syndrome''' | |||
|- | |- | ||
| | | valign = top | | ||
'''Disorders of glycogenolysis''' | |||
| | *[[Glycogen storage disease type V|Myophosphorylase deficiency]] | ||
| | *[[Phosphorylase kinase|Phosphorylase kinase deficiency]] | ||
| | '''Disorders of glycolysis''' | ||
| ''' | *[[Phosphofructokinase deficiency]] | ||
*[[Phosphoglycerate kinase|Phosphoglycerate kinase deficiency]] | |||
*[[Phosphoglycerate mutase|Phosphoglycerate mutase deficiency]] | |||
|- | *[[Lactate dehydrogenase|Lactate dehydrogenase deficiency]] | ||
'''Disorders of lipid metabolism''' | |||
| | *[[Carnitine palmitoyltransferase deficiency]] | ||
*[[Carnitine deficiency]] | |||
| | *[[Short-chain acyl-coenzyme A dehydrogenase deficiency]] | ||
*[[Long-chain acyl-CoA dehydrogenase deficiency]] | |||
*[[LPIN1|Lipin-1 deficiency]] | |||
'''Disorders of purine metabolism''' | |||
*[[Myoadenylate deaminase deficiency]] | |||
Other defects | |||
*[[Malignant hyperthermia]] susceptibility caused by RYR1 gene mutations | |||
*[[Alpha-methylacyl-CoA racemase|Alpha-methylacyl-CoA racemase (AMACR) deficiency]] | |||
*[[Adenosine triphosphate|Brody myopathy]] ([[Adenosine triphosphate|Calcium adenosine triphosphatase deficiency]]) | |||
| valign = top | | |||
| | *[[Myopathy|Isolated myopathy]] | ||
*[[Chronic Progressive External Ophthalmoplegia]] | |||
*[[Kearns-Sayre syndrome]] | |||
| ''' | *[[Mitochondrial myopathy|Severe encephalomyopathy of infancy or childhood]] | ||
*[[Barth syndrome]] | |||
*[[GRACILE syndrome]] | |||
*[[Leigh's disease]] | |||
*[[Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes]] (MELAS) | |||
*[[Myoclonic epilepsy with ragged red fibers]] (MERRF) | |||
| valign = top | | |||
'''Volatile anesthetic agent''' | |||
*[[Halothane]] | |||
*[[Isoflurane]] | |||
*[[Sevoflurane]] | |||
*[[Desflurane]] | |||
'''Depolarising Neuro-Muscular Blocker''' | |||
*[[Succinylcholine]] | |||
| valign = top | | |||
'''Neuroleptics''' | |||
*[[Aripiprazole]] | |||
*[[Asenapine maleate]] | |||
*[[Chlorpromazine]] | |||
*[[Clozapine]] | |||
*[[Fluphenazine]] | |||
*[[Haloperidol]] | |||
*[[Iloperidone]] | |||
*[[Loxapine]] | |||
*[[Olanzapine]] | |||
*[[Paliperidone]] | |||
*[[Perphenazine]] | |||
*[[Prochlorperazine]] | |||
*[[Quetiapine]] | |||
*[[Risperidone]] | |||
*[[Thioridazine]] | |||
*[[Thiothixene]] | |||
*[[Trifluoperazine]] | |||
*[[Ziprasidone]] | |||
'''Antiemetic agents''' | |||
*[[Domperidone]] | |||
*[[Droperidol]] | |||
*[[Metoclopramide]] | |||
*[[Prochlorperazine]] | |||
*[[Promethazine]] | |||
'''Anti Parkison drug withdrawl''' | |||
*[[L-dopa]] | |||
*[[Bromocriptine]] | |||
*[[Cabergoline]] | |||
|} | |||
{| border="2" cellpadding="5" cellspacing="0" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;" width="75%" | |||
! colspan="2" |'''Non-Traumatic Non-Exertional Causes''' | |||
|- | |- | ||
|- | |{{Center|'''Infections'''}} | ||
| ''' | | '''''Viral infections''''' :<br> [[Adenovirus]], [[Coxsackievirus]], [[Cytomegalovirus]], [[Echovirus]] , [[Epstein-Barr]] , [[Herpes simplex]], [[Human immunodeficiency virus]], [[Influenza|Influenza A and B]], [[Parainfluenza]]<br>'''''Bacterial infections''''' :<br> [[Pyomyositis|Bacterial pyomyositis]], [[Coxiella burnetii]]([[Q fever]]), [[E. coli]], [[Ehrlichiosis]],[[Plasmodium falciparum|Falciparum malaria]], [[Legionella]], [[Leptospirosis]], [[Mycoplasma pneumoniae]], [[Salmonella]], [[Staphylococcal infection]], [[Streptococcus]], [[Tularemia]] | ||
| | |||
|- | |- | ||
| | |{{Center|'''Electrolyte abnormalities'''}} | ||
| ''' | | [[Hypokalemia]], [[Hypophosphatemia]] | ||
| | |||
|- | |- | ||
| | |{{Center|'''Endocrinopathies'''}} | ||
| ''' | | [[Hypothyroidism]], [[Diabetic ketoacidosis]] , [[Hyperglycemia|Non-ketotic hyperglycemia]] | ||
| | |||
|- | |- | ||
| | |{{Center|'''Inflammatory myopathies'''}} | ||
| [[Dermatomyositis]], [[Polymyositis]] | |||
| ''' | |||
| | |||
|- | |- | ||
|{{Center|'''Miscellaneous'''}} | |||
| [[Alcoholism]], [[Baclofen|Baclofen withdrawl]], [[Capillary leak syndrome]], [[Status asthmaticus]] | |||
|} | |} | ||
=== Causes by Alphabetical Order === | |||
{{columns-list| | |||
*[[Adenovirus]] | |||
*[[Alcoholism]] | |||
*[[Alpha-methylacyl-CoA racemase|Alpha-methylacyl-coa racemase (amacr) deficiency]] | |||
*[[Parkinson's disease medical therapy|Anti parkison drug withdrawl]] | |||
*[[Antiemetic|Antiemetic agents]] | |||
*[[Aripiprazole]] | |||
*[[Asenapine maleate]] | |||
*[[Baclofen|Baclofen withdrawl]] | |||
*[[Pyomyositis|Bacterial pyomyositis]] | |||
*[[Barth syndrome]] | |||
*[[Adenosine triphosphate|Brody myopathy]] ([[Adenosine triphosphate|calcium adenosine triphosphatase deficiency]]) | |||
*[[Bromocriptine]] | |||
*[[Burns]] | |||
*[[Cabergoline]] | |||
*[[Capillary leak syndrome]] | |||
*[[Carnitine deficiency]] | |||
*[[Carnitine palmitoyltransferase deficiency]] | |||
*[[Chlorpromazine]] | |||
*[[Chronic Progressive External Ophthalmoplegia]] | |||
*[[Clozapine]] | |||
*[[Coma]] | |||
*[[Compartment syndrome]] | |||
*[[Coxiella burnetii]] ([[Q fever]]) | |||
*[[Coxsackievirus]] | |||
*[[Crush injury]] | |||
*[[Cytomegalovirus]] | |||
*[[Neuromuscular-blocking drugs|Depolarising neuro-muscular blocker]] | |||
*[[Dermatomyositis]] | |||
*[[Desflurane]] | |||
*[[Diabetic ketoacidosis]] | |||
*[[Domperidone]] | |||
*[[Droperidol]] | |||
*[[E. coli]] | |||
*[[Echovirus]] | |||
*[[Ehrlichiosis]] | |||
*[[Electrical injury]] | |||
*[[Electrolyte abnormalities]] | |||
*[[Endocrinology|Endocrinopathies]] | |||
*[[Epstein-Barr|Epstein-barr ]] | |||
*[[Plasmodium falciparum|Falciparum malaria]] | |||
*[[Fluphenazine]] | |||
*[[GRACILE syndrome]] | |||
*[[Haloperidol]] | |||
*[[Halothane]] | |||
*[[Herpes simplex]] | |||
*[[Human immunodeficiency virus]] | |||
*[[Hypokalemia]] | |||
*[[Hypophosphatemia]] | |||
*[[Hypothyroidism]] | |||
*[[Iloperidone]] | |||
*[[Immobility|Immobilizaion]] | |||
*[[Polymyositis|Inflammatory myopathies]] | |||
*[[Influenza|Influenza A and B]] | |||
*[[Isoflurane]] | |||
*[[Myopathy|Isolated myopathy]] | |||
*[[Kearns-Sayre syndrome]] | |||
*[[Lactate dehydrogenase|Lactate dehydrogenase deficiency]] | |||
*[[L-dopa]] | |||
*[[Legionella]] | |||
*[[Leigh's disease]] | |||
*[[Leptospirosis]] | |||
*[[LPIN1|Lipin-1 deficiency]] | |||
*[[Long-chain acyl-CoA dehydrogenase deficiency]] | |||
*[[Loxapine]] | |||
*[[Malignant hyperthermia]] | |||
*[[Malignant hyperthermia]] susceptibility caused by ryr1 gene mutations | |||
*[[Myopathy|Metabolic myopathies]] | |||
*[[Metoclopramide]] | |||
*[[Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes]] (MELAS) | |||
*[[Mitochondrial myopathy|Mitochondrial myopathies]] | |||
*[[Mycoplasma pneumoniae]] | |||
*[[Myoadenylate deaminase deficiency]] | |||
*[[Myoclonic epilepsy with ragged red fibers]] (MERRF) | |||
*[[Glycogen storage disease type V|Myophosphorylase deficiency]] | |||
*[[Neuroleptic malignant syndrome]] | |||
*[[Neuroleptics]] | |||
*[[Hyperglycemia|Non-ketotic hyperglycemia]] | |||
*[[Olanzapine]] | |||
*[[Paliperidone]] | |||
*[[Parainfluenza]] | |||
*[[Perphenazine]] | |||
*[[Phosphofructokinase|Phosphofructokinase deficiency]] | |||
*[[Phosphoglycerate kinase|Phosphoglycerate kinase deficiency]] | |||
*[[Phosphoglycerate mutase|Phosphoglycerate mutase deficiency]] | |||
*[[Phosphorylase kinase|Phosphorylase kinase deficiency]] | |||
*[[Polymyositis]] | |||
*[[Post operative complications|Post - operative surgical trauma]] | |||
*[[Post ictal state]] | |||
*[[Prochlorperazine]] | |||
*[[Promethazine]] | |||
*[[Quetiapine]] | |||
*[[Risperidone]] | |||
*[[Salmonella]] | |||
*[[Mitochondrial myopathy|Severe encephalomyopathy of infancy or childhood]] | |||
*[[Sevoflurane]] | |||
*[[Short-chain acyl-coenzyme A dehydrogenase deficiency]] | |||
*[[Staphylococcal infection]] | |||
*[[Status asthmaticus]] | |||
*[[Streptococcus]] | |||
*[[Succinylcholine]] | |||
*[[Thioridazine]] | |||
*[[Thiothixene]] | |||
*[[Trifluoperazine]] | |||
*[[Tularemia]] | |||
*[[Volatile anaesthetic|Volatile anesthetic agent]] | |||
*[[Ziprasidone]] | |||
}} | |||
==References== | ==References== |
Latest revision as of 22:39, 10 January 2020
Rhabdomyolysis Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Rhabdomyolysis causes On the Web |
American Roentgen Ray Society Images of Rhabdomyolysis causes |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]
Overview
The aetiological spectrum of rhabdomyolysis is extensive in many cases, multiple muscle insults are usually needed to produce rhabdomyolysis unless an underlying myopathy is present. The most common causes of rhabdomyolysis in adults are illicit drugs, alcohol abuse, medication, muscle diseases, trauma, neuroleptic malignant syndrome (NMS), seizures and immobility, Whereas in paediatric patients, the most common causes are viral myositis, trauma, connective tissue disorders, exercise, and drug overdose.[1]
Causes
Life-Threatening Causes
- Burns
- Crush injury
- Electrical injury
- Exertional Heat stroke
- Compartmental syndrome
- Malignant hyperthermia
- Neuroleptic malignant syndrome
- Electrolyte abnormalities such as Hypokalemia
Common Causes
- Burns
- crush injury
- Long-lasting muscle compression in Coma patients, under the influence of alcohol, medication or illicit drugs
- Electrical injury
- Snake venom
- Heat stroke
- Seizures
Causes by Pathophysiology
Rhadomyolysis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Traumatic or Muscle Compression | Non - Traumatic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Non-Traumatic Exertional | Non-Traumatic Non-Exertional | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Non - Traumatic Exertional Rhadomyolysis in a Normal Muscle | Non - Traumatic Exertional Rhadomyolysis in an Abnormal Muscle | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Crush injury ❑ Coma ❑ Post ictal state ❑ Post - Operative Surgical trauma ❑ Electrical Injury ❑ Compartment Syndrome ❑ Immobilizaion | ❑ Exertional Heat Stroke ❑ Sickle cell trait ❑ Hyperkinetic States Such as * Grand mal Seizures * Delirium tremens * Psychotic agitation * Amphetamine Overdose | ❑ Metabolic myopathies ❑ Mitochondrial myopathies ❑ Malignant hyperthermia ❑ Neuroleptic malignant syndrome | ❑ Drugs and toxins ❑ Infections ❑ Electrolyte abnormalities ❑ Endocrinopathies ❑ Inflammatory myopathies ❑ Miscellaneous | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Non-Traumatic Non-Exertional Causes | |
---|---|
Infections
|
Viral infections : Adenovirus, Coxsackievirus, Cytomegalovirus, Echovirus , Epstein-Barr , Herpes simplex, Human immunodeficiency virus, Influenza A and B, Parainfluenza Bacterial infections : Bacterial pyomyositis, Coxiella burnetii(Q fever), E. coli, Ehrlichiosis,Falciparum malaria, Legionella, Leptospirosis, Mycoplasma pneumoniae, Salmonella, Staphylococcal infection, Streptococcus, Tularemia |
Electrolyte abnormalities
|
Hypokalemia, Hypophosphatemia |
Endocrinopathies
|
Hypothyroidism, Diabetic ketoacidosis , Non-ketotic hyperglycemia |
Inflammatory myopathies
|
Dermatomyositis, Polymyositis |
Miscellaneous
|
Alcoholism, Baclofen withdrawl, Capillary leak syndrome, Status asthmaticus |
Causes by Alphabetical Order
- Adenovirus
- Alcoholism
- Alpha-methylacyl-coa racemase (amacr) deficiency
- Anti parkison drug withdrawl
- Antiemetic agents
- Aripiprazole
- Asenapine maleate
- Baclofen withdrawl
- Bacterial pyomyositis
- Barth syndrome
- Brody myopathy (calcium adenosine triphosphatase deficiency)
- Bromocriptine
- Burns
- Cabergoline
- Capillary leak syndrome
- Carnitine deficiency
- Carnitine palmitoyltransferase deficiency
- Chlorpromazine
- Chronic Progressive External Ophthalmoplegia
- Clozapine
- Coma
- Compartment syndrome
- Coxiella burnetii (Q fever)
- Coxsackievirus
- Crush injury
- Cytomegalovirus
- Depolarising neuro-muscular blocker
- Dermatomyositis
- Desflurane
- Diabetic ketoacidosis
- Domperidone
- Droperidol
- E. coli
- Echovirus
- Ehrlichiosis
- Electrical injury
- Electrolyte abnormalities
- Endocrinopathies
- Epstein-barr
- Falciparum malaria
- Fluphenazine
- GRACILE syndrome
- Haloperidol
- Halothane
- Herpes simplex
- Human immunodeficiency virus
- Hypokalemia
- Hypophosphatemia
- Hypothyroidism
- Iloperidone
- Immobilizaion
- Inflammatory myopathies
- Influenza A and B
- Isoflurane
- Isolated myopathy
- Kearns-Sayre syndrome
- Lactate dehydrogenase deficiency
- L-dopa
- Legionella
- Leigh's disease
- Leptospirosis
- Lipin-1 deficiency
- Long-chain acyl-CoA dehydrogenase deficiency
- Loxapine
- Malignant hyperthermia
- Malignant hyperthermia susceptibility caused by ryr1 gene mutations
- Metabolic myopathies
- Metoclopramide
- Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS)
- Mitochondrial myopathies
- Mycoplasma pneumoniae
- Myoadenylate deaminase deficiency
- Myoclonic epilepsy with ragged red fibers (MERRF)
- Myophosphorylase deficiency
- Neuroleptic malignant syndrome
- Neuroleptics
- Non-ketotic hyperglycemia
- Olanzapine
- Paliperidone
- Parainfluenza
- Perphenazine
- Phosphofructokinase deficiency
- Phosphoglycerate kinase deficiency
- Phosphoglycerate mutase deficiency
- Phosphorylase kinase deficiency
- Polymyositis
- Post - operative surgical trauma
- Post ictal state
- Prochlorperazine
- Promethazine
- Quetiapine
- Risperidone
- Salmonella
- Severe encephalomyopathy of infancy or childhood
- Sevoflurane
- Short-chain acyl-coenzyme A dehydrogenase deficiency
- Staphylococcal infection
- Status asthmaticus
- Streptococcus
- Succinylcholine
- Thioridazine
- Thiothixene
- Trifluoperazine
- Tularemia
- Volatile anesthetic agent
- Ziprasidone
References
- ↑ Khan FY (2009) Rhabdomyolysis: a review of the literature. Neth J Med 67 (9):272-83. PMID: 19841484