Rhabdomyolysis is a condition in which skeletal muscle breakdown occurs. This may arise from a number of causes, including crushing injuries, strenuous exercise, drugs and infections. Water moves into the damaged muscle cells and the contents of the cells are released into the circulation, leading to problems such as kidney failure and blood clotting. Rhabdomyolysis treatment generally involves rehydration to maintain the body's fluid balance, administration of alkaline substances to prevent the urine from becoming too acidic, and blood transfusions to prevent clotting. Surgery is sometimes used in the early stages to remove areas of severely damaged muscle before problems occur.
The muscle deterioration seen in rhabdomyolysis was originally recognized in World War II, when people became crushed underneath fallen buildings during bombing raids. As the muscle cells break down, electrolytes such as potassium, phosphate and sulphate are released into the blood stream, and water moves out of the blood into the cells. The released electrolytes can have a toxic effect on the kidneys and cause widespread blood clotting, leading to other organs failing. A lower blood volume, due to loss of water, means insufficient blood flows through the kidneys, further increasing the risk of renal failure. Rhabdomyolysis treatment commonly involves correcting the body's abnormal fluid and electrolyte balance before life-threatening complications occur.
In the initial stages of rhabdomyolysis treatment, fluids are given to maintain the volume of blood, and these are administered into a vein. If the patient has suffered an accident, any serious injuries are attended to at the same time, and the airway and breathing maintained. Where extensive crushing has affected a limb, it is sometimes amputated before the effects of rhabdomyolysis take place. Smaller areas of badly damaged muscle may also be surgically removed as a preventive form of rhabdomyolysis treatment.
Alkaline substances, such as sodium bicarbonate, may be required during rhabdomyolysis treatment, as making the urine less acidic has been shown to help prevent the kidneys from failing. Sodium bicarbonate is given intravenously, into a vein, along with other fluids. If the amount of potassium in the blood becomes too high, this can stop the heart from working normally. High potassium levels can also be treated using intravenous sodium bicarbonate, along with glucose, insulin and other medications. If levels do not improve, kidney dialysis might be needed.
In cases where extensive blood clotting starts to occur, known as disseminated intravascular coagulation, or DIC, this can cause damage to tissues and organs throughout the body. Clotting blocks the blood supply to tissues and, when all the clotting substances in the blood have been used up, hemorrhages occur, with bleeding from various parts of the body. Rhabdomyolysis treatment to prevent the complications of DIC involves giving transfusions of fresh blood products to help stabilize the condition.