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    Generalidades de La Rabdomiolisis: Dra. Kelly Ortiz Villarreal Residente I Medicina Interna

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    Rhabdomyolysis is the breakdown of skeletal muscle that results in the release of intracellular contents into circulation. It can cause acute kidney injury in 7-10% of cases, with mortality rates reaching 22-59% in patients who develop kidney injury. The pathophysiology involves compression, ischemia or activation of leukocytes in muscle tissue leading to necrosis. Diagnosis is based on evidence of tissue damage, elevated creatine phosphokinase levels in blood, dark urine, and urine dipstick positive for blood without red blood cells. Treatment focuses on fluid resuscitation, electrolyte management, maintaining urine output, and using bicarbonate or mannitol to alkalinize urine pH.

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    Generalidades de La Rabdomiolisis: Dra. Kelly Ortiz Villarreal Residente I Medicina Interna

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    dantheman123
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    Rhabdomyolysis is the breakdown of skeletal muscle that results in the release of intracellular contents into circulation. It can cause acute kidney injury in 7-10% of cases, with mortality rates reaching 22-59% in patients who develop kidney injury. The pathophysiology involves compression, ischemia or activation of leukocytes in muscle tissue leading to necrosis. Diagnosis is based on evidence of tissue damage, elevated creatine phosphokinase levels in blood, dark urine, and urine dipstick positive for blood without red blood cells. Treatment focuses on fluid resuscitation, electrolyte management, maintaining urine output, and using bicarbonate or mannitol to alkalinize urine pH.

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    Rhabdomyolysis is the breakdown of skeletal muscle that results in the release of intracellular contents into circulation. It can cause acute kidney injury in 7-10% of cases, with mortality rates reaching 22-59% in patients who develop kidney injury. The pathophysiology involves compression, ischemia or activation of leukocytes in muscle tissue leading to necrosis. Diagnosis is based on evidence of tissue damage, elevated creatine phosphokinase levels in blood, dark urine, and urine dipstick positive for blood without red blood cells. Treatment focuses on fluid resuscitation, electrolyte management, maintaining urine output, and using bicarbonate or mannitol to alkalinize urine pH.

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    27 views13 pages

    Generalidades de La Rabdomiolisis: Dra. Kelly Ortiz Villarreal Residente I Medicina Interna

    Uploaded by

    dantheman123
    Rhabdomyolysis is the breakdown of skeletal muscle that results in the release of intracellular contents into circulation. It can cause acute kidney injury in 7-10% of cases, with mortality rates reaching 22-59% in patients who develop kidney injury. The pathophysiology involves compression, ischemia or activation of leukocytes in muscle tissue leading to necrosis. Diagnosis is based on evidence of tissue damage, elevated creatine phosphokinase levels in blood, dark urine, and urine dipstick positive for blood without red blood cells. Treatment focuses on fluid resuscitation, electrolyte management, maintaining urine output, and using bicarbonate or mannitol to alkalinize urine pH.

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    of 13

    GENERALIDADES DE LA

    RABDOMIOLISIS
    Dra. Kelly Ortiz Villarreal
    Residente I
    Medicina Interna
    DEFINICION
    Es la liberacion de
    componentes del
    musculo esqueletico
    lesionado a la
    circulacion: Electrolitos,
    mioglobina, proteinas
    sarcoplasmicas (CPK,
    aldolasa, LDH, AST, ALT)

    Current Concepts -Rhabdomyolysis and Acute Kidney Injury N Engl J Med 361;1 . July 2, 2009
    EPIDEMIOLOGIA
    • Causa del 7 - 10% de las IRA.

    • Mortalidad : 22% y 59% + IRA.

    • Supervivencia hasta 80%.

    Crush injury and rhabdomyolysis. Crit Care Clin 20 (2004) 171– 192.
    Current Concepts -Rhabdomyolysis and Acute Kidney Injury N Engl J Med 361;1 . July 2, 2009
    Current Concepts -Rhabdomyolysis and Acute Kidney Injury N Engl J Med 361;1 . July 2, 2009
    FISIOPATOLOGIA
    • Compresion
    Muscular
    • Isquemia
    Muscular
    • Activación de los
    leucocitos

    Tierra, mar y aire. Edf. Mezrahi.

    Crush injury and Rhabdomyolysis. Crit Care Clin 20 (2004) 171– 192.
    Fisiopatologia
    • 2 hrs de isquemia: Daño irreversible
    anatomico y funcional.
    • Necrosis muscular: 6 horas.
    • 24 hrs: Injuria Maxima

    Crush injury and rhabdomyolysis. Crit Care Clin 20 (2004) 171– 192.
    Fisiopatologia Renal
    • Diminucion de la
    Perfusion renal.
    • Obstruccion Tubular.
    • Toxicidad directa de la
    Mioglobina: Radicales
    libres y lipo
    perioxidacion.

    Crush injury and rhabdomyolysis. Crit Care Clin 20 (2004) 171– 192.
    Current Concepts -Rhabdomyolysis and Acute Kidney Injury N Engl J Med 361;1 . July 2, 2009
    Manifestaciones Clinicas
    • Dolor, edema,
    parestesias o paresias
    de la extremidad
    comprometida.
    • Cilindros granulosos
    pigmentados,
    sobrenadante urinario
    rojizo- marron.
    • Elevacion de la
    creatinkinasa.
    Crush injury and rhabdomyolysis. Crit Care Clin 20 (2004) 171– 192.
    Current Concepts -Rhabdomyolysis and Acute Kidney Injury N Engl J Med 361;1 . July 2, 2009
    DIAGNOSTICO

    1. LESION TISULAR
    2. CPK TOTAL: Mas rapido
    y sencillo
    3. ORINA OSCURA
    4. TIRILLA POSITIVA PARA
    SANGRE EN AUSENCIA
    DE HEMATIES

    Crush injury and rhabdomyolysis. Crit Care Clin 20 (2004) 171– 192.
    Current Concepts -Rhabdomyolysis and Acute Kidney Injury N Engl J Med 361;1 . July 2, 2009
    TRATAMIENTO
    Volemia pH
    Estabilidad hemodinamica pH urinario: 6 – 7, si es
    y prevenir sobrecargas. menor de 6, iniciar
    Gasto urinario: 200 mL /hr bicarbonato: 1 litro de
    (3mml/kilo) salina / 1 lityo de dad 5% +
    LEV: 200 – 1000 cc /hr. 100 mOm de Bicarbonato.
    pH: serico: < 7.50.

    Electrolitos Diureticos
    K, PO4, Ca, Creatinina, Manitol: Si se ha
    BUN. recuperado la Volemia,
    iniciar.
    Dosis: 200 gr -800gr/dia.
    Crush injury and rhabdomyolysis. Crit Care Clin 20 (2004) 171– 192.
    Current Concepts -Rhabdomyolysis and Acute Kidney Injury N Engl J Med 361;1 . July 2, 2009
    La Columna Rota
    1944
    Frida Khalo
    1907- 1953
    Otras Bibliografias
    • Rhabdomyolysis, myoglobinuria, and
    necrotizing myopathies. Vet Clin Small Anim
    34 (2004) 1469–1482.
    • Nephrotoxicity of over-the-counter analgesics,
    natural medicines, and illicit drugs. Adolesc
    Med 16 (2005) 31–43.
    • Toxic Myopathies. Neurol Clin 23 (2005) 397–
    428.

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