How does rhabdomyolysis affect the urinary system?
Rhabdomyolysis is a serious syndrome due to a direct or indirect muscle injury. It results from the death of muscle fibers and release of their contents into the bloodstream. This can lead to serious complications such as renal (kidney) failure. This means the kidneys cannot remove waste and concentrated urine.
Why does rhabdo cause alkaline urine?
Raising the pH of the urine to 6.5 or more can be facilitated by adding sodium bicarbonate to the fluids. Alkalinization of the urine has been postulated to minimize the breakdown of myoglobin into its nephrotoxic metabolites and to reduce crystallization of uric acid, thereby decreasing damage to tubule cells.
How is rhabdomyolysis detected in urine?
Repeated blood tests for the muscle protein creatine kinase (CK or creatine phosphokinase [CPK]) are the only accurate test for rhabdo.
- These tests check for myoglobin (a muscle cell component) indirectly.
- Myoglobin quickly clears from the body so it may not show up in urine.
What is the classic triad of symptoms in rhabdomyolysis?
The classic triad of symptoms of rhabdomyolysis consists of myalgia, weakness, and tea-colored urine.
Can rhabdomyolysis cause UTI?
Rhabdomyolysis is linked to infection in up to 31% of cases. However, only 19 cases of rhabdomyolysis related to E coli infection have been reported.
Why is urine dark in rhabdomyolysis?
Release of the components of muscle tissue into the bloodstream causes electrolyte disturbances, which can lead to nausea, vomiting, confusion, coma or abnormal heart rate and rhythm. The urine may be dark, often described as “tea-colored”, due to the presence of myoglobin.
What is urinary alkalinization?
Urine alkalinization is a treatment regimen that increases poison elimination by the administration of intravenous sodium bicarbonate to produce urine with a pH > or = 7.5.
Why do we give sodium bicarbonate in rhabdomyolysis?
Approximately 50% of the sodium can be administered as sodium bicarbonate. This helps to correct the acidosis induced by the release of protons from damaged muscles, to prevent precipitation of myoglobin in the tubules, and to reduce the risk of hyperkalemia.
Does rhabdo always have dark urine?
At a high concentration, myoglobin excreted into the urine (myoglobinuria) changes the color of the urine to red or brown and can be confirmed with a urine test. However, a person can have rhabdomyolysis without also having discolored urine.
How does rhabdomyolysis cause renal failure?
The main mechanism of kidney damage in patients with rhabdomyolysis is the massive release of myoglobin into the circulation, with myoglobinuria.
Can you have rhabdo with normal urine?
Does rhabdomyolysis cause proteinuria?
Patients with rhabdomyolysis may exhibit proteinuria of varying degrees. This is because of the overflow excretion of urinary myoglobin and low molecular weight proteins and the altered glomerular permeability induced by either myoglobin or other substances released from muscles.
Does urine alkalinization increase salicylate elimination?
Experimental and clinical studies confirm that urinary alkalinization increases salicylate elimination, although the mechanisms by which this occurs have not been elucidated. The conventional view is that ionisation of a weak acid, such as salicylic acid, is increased in an alkaline environment.
What is the importance of acidifying or alkalizing urine?
Secretion of an acid or alkaline urine by the kidneys is one of the most important mechanisms the body uses to maintain a constant body pH. A highly acidic urine pH occurs in: Acidosis. Uncontrolled diabetes.
Which clinical finding would be expected in the patient with rhabdomyolysis?
Main clinical manifestations – The clinical manifestations of rhabdomyolysis include myalgias, weakness, red to brown urine due to myoglobinuria, and elevated serum muscle enzymes, including creatine kinase (CK). The degree of myalgias and other symptoms varies widely, and some patients are asymptomatic.
What is the most serious complication of rhabdomyolysis?
Clinical features of rhabdomyolysis may be absent initially, and its most serious complication, acute renal failure, is common. Many patients develop dialysis-dependent acute renal failure associated with the misuse of alcohol or other drugs.
How do you increase renal excretion of salicylate?
Increasing urine pH increases the excreted salicylate. Alkaline diuresis can be initiated by intravenous NaHCO3 administration or by acetazolamide therapy. The goal is to maintain the urine pH at greater than 7.5 until the salicylate level falls below 30-50 mg/dL.
What does alkaline urine indicate?
Very alkaline urine (pH > 7.0) is suggestive of infection with a urea-splitting organism, such as Proteus mirabilis. Prolonged storage can lead to overgrowth of urea-splitting bacteria and a high urine pH.
When is urinary alkalization indicated in the treatment of rhabdomyolysis?
It is recommended for patients with rhabdomyolysis and CK levels higher than 6000 IU/L. Urinary alkalization should be considered earlier in patients with acidemia, dehydration, or underlying renal disease.
What is rhabdomyolysis?
Practice Essentials. Rhabdomyolysis is a syndrome caused by injury to skeletal muscle and involves leakage of large quantities of potentially toxic intracellular contents into plasma.
What is the role of alkalinization in the treatment of urinalysis?
Alkalinization may also reduce the occurrence of cast formation (ferrihemate and myoglobin). Some authorities believe that aggressive hydration sufficiently causes a solute diuresis that alkalizes the urine. Evidence for the use of these agents is mostly from animal studies and retrospective adult studies.
What is the risk of acute kidney injury (AKI) from rhabdomyolysis?
AKI is the most common complication of rhabdomyolysis. The risk of AKI is less in patients with CPK levels less than 20,000 IU/L. Patients with CK levels of more than 40,000 IU/L have an increased risk of acute kidney injury.