- See:
Compartment Syndrome:
- Discussion:
- traumatic rhabdomyolysis, or crush syndrome, is consequence of prolonged continuous pressure on the limbs;
- it reflects disintegration of muscle tissue & influx of myoglobin, potassium, and phosphorus into the circulation;
- syndrome is characterized by hypovolemic shock and
hyperkalemia;
- these results strongly suggest that free-radical scavengers are beneficial in attenuating or preventing reperfusion-induced injury
to ischemic skeletal muscles and consequently to other organs, particularly the kidneys;
- these scavengers should be administered before crushed muscles are decompressed or as early as possible during reperfusion
in order to prevent irreversible damage to ischemic cells;
- Labs:
- urine myoglobin;
-
serum CPK
-
chemistry panel
- Treatment:
- fluid requirements:
- it is quite common in extensive traumatic rhabdomyolysis for muscles of 75-kg adult to sequester greater/= 12 liters of
fluid over 48-hour period (i.e. amount of same order of magnitude as entire volume of extracellular fluid);
- if inadequately corrected, this potentially fatal hypovolemia may cause renal ischemia by activating secretion of constrictor
hormones, such as angiotensin II, catecholamines, vasopressin, and intrarenal thromboxane;
- alkalinization of urine;
-
bicarbonate:
-
acetazolamide
- medical therapy:
-
mannitol
- scavenger of hydroxyl free radicals, & allopurinol, xanthine oxidase inhibitor & protects against myocardial necrosis;
- scavengers also limit tissue injury during ischemia & reperfusion of intestine, the kidney, liver, and island skin flaps;
- allopurinol
-
benzamil
-
amiloride
- KCl-sparing diuretic drug, decreases intracellular sodium concentration & inhibits Na-hydrogen & Na-calcium exchange in many tissues;
- renal failure
- pathogenesis of renal failure in rhabdomyolysis and the crush syndrome is still not fully understood;
- direct toxic effects of myoglobin or products of decomposition;
-
dehydration is predisposing factor for renal failure;
- avoid IV Ca:
- unless there is danger of
hyperkalemic arrhythmia, infusion of calcium is not indicated;
- unless calcium is constantly infused, its administration will correct
hypocalcemia only temporarily; most infused calcium
is deposited in injured muscles, thus aggravating rhabdomyolysis & causing metastatic calcification;
- metastatic calcification:
- danger that mild
metabolic alkalosis resulting from mannitol-alkaline diuresis therapy may enhance metastatic calcification;
Mechanisms of Disease: The Role Of Reperfusion-Induced Injury In The Pathogenesis Of The Crush Syndrome.
Reperfusion pulmonary edema.
Reperfusion injury in skeletal muscle: a prospective study in patients with acute limb ischaemia and claudicants treated by revascularization
Deferoxamine attenuates ischemia-induced reperfusion injury in the skin and muscle of myocutaneous flaps in the pig.
Blockade of complement activation prevents local and pulmonary albumin leak after lower torso ischemia-reperfusion.
Identification of xanthine oxidase activity following reperfusion in human tissue.
