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Ramdeny PS, Powell C, Chakraborty M, Hartley L. Rhabdomyolysis in Stuve-Wiedemann syndrome. BMJ Case Rep 2018; 2018:bcr-2017-222863. [DOI: 10.1136/bcr-2017-222863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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202
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Mandato C, Rossi A, Caldore M, Lamba M, Rocco M, Auricchio R, Vajro P, Siani P. Rhabdomyolysis and coeliac disease: A causal or casual association? A case report and review of literature. Clin Res Hepatol Gastroenterol 2018; 42:e7-e13. [PMID: 28606713 DOI: 10.1016/j.clinre.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/05/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rhabdomyolysis is a rare, potentially life-threatening condition, caused by multiple disorders. The association with Coeliac Disease (CD) has been rarely reported and in these cases muscular damage was imputed to hypokalemia. Herein we describe a new case of severe rhabdomyolysis in a child subsequently diagnosed as affected by CD, and review previous reports. CASE PRESENTATION A 3-year-old boy was referred for diarrhea, brown urine, muscular pain/weakness, and no history of muscular trauma. At entry, laboratory tests showed elevated levels of creatine kinase (CK) (x100 unv) and aspartate aminotransferase (AST) (x10 unv), alanine aminotrasferase (ALT) (x5 unv); electrolytes were within the reference range. Twenty-four hours after admission serum CK peaked 115,000 U/L and transaminases increased up to 30 times unv. Hyperhydration treatment was started with renal function monitoring. Urine output decreased little, while serum creatinine and urea nitrogen stayed within the reference range. Serum potassium levels went down to 2.8 mEq/L at day 3, in spite of supplementation. The patient completely recovered at day 16. Main metabolic causes of rhabdomyolysis were ruled out by appropriate tests. Because of rarely reported cases of CD/rhabdomyolysis, anti-tissue transglutaminase (tTG) antibodies were measured and found positive (IgA 34 U/mL, unv <9). HLA typing was DQA1 05:02, DQB1 03:02. As jejunal biopsy showed patchy villous atrophy, gluten free diet (GFD) was prescribed. One year after starting GFD, histology was normal. REVIEW OF LITERATURE Literature (search engines: PUB MED and GOOGLE SCHOLAR) from 1980 to 2016 retrieved 8 cases (age range: 12 to 75 years old) previously described. CONCLUSION The present case suggests to check for CD in children with severe rhabdomyolysis. Because severe rhabdomyolysis itself may elevate the serum potassium levels, hypokalemia might go unrecognized as the cause of muscular damage.
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Affiliation(s)
- Claudia Mandato
- Department of Pediatrics, AORN Santobono-Pausilipon, via M. Fiore, 80129 Naples, Italy.
| | - Alessandro Rossi
- Department of Traslational Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Mariano Caldore
- Department of Pediatrics, AORN Santobono-Pausilipon, via M. Fiore, 80129 Naples, Italy
| | - Marta Lamba
- Department of Pediatrics, AORN Santobono-Pausilipon, via M. Fiore, 80129 Naples, Italy
| | - Michele Rocco
- Department of Services, Pathology, AORN Santobono-Pausilipon, via M. Fiore, 80129 Naples, Italy
| | - Renata Auricchio
- Department of Traslational Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Pietro Vajro
- Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, 84081, Baronissi (Salerno), Italy
| | - Paolo Siani
- Department of Pediatrics, AORN Santobono-Pausilipon, via M. Fiore, 80129 Naples, Italy
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203
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Padula AM, Ong HM, Kelers K. Snake Envenomation in Domestic Animal Species in Australia. CLINICAL TOXINOLOGY IN AUSTRALIA, EUROPE, AND AMERICAS 2018. [DOI: 10.1007/978-94-017-7438-3_66] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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204
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Evaluation of rhabdomyolysis patients who opted for emergency services. North Clin Istanb 2017; 4:257-261. [PMID: 29270575 PMCID: PMC5724921 DOI: 10.14744/nci.2017.85619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 07/06/2017] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE: Rhabdomyolysis is a clinical and biochemical syndrome caused by skeletal muscle injury. Our aim was to contribute to the existing data on rhabdomyolysis in our country by evaluating the etiologic, demographic, and clinical features of rhabdomyolysis patients who applied to a tertiary hospital emergency department. METHODS: We retrospectively evaluated the data of patients who applied to the tertiary hospital emergency department from January 2015 to January 2016. The study population comprised patients admitted to the emergency department of our hospital with creatinine kinase levels above 5000 U/L at admission. The data of all cases that were included in the study were scanned by the researchers using the hospital’s computer-based data recording system. Age, sex, creatine kinase levels, complaints, etiology, whether or not acute renal failure developed, hospitalization and discharge status, and clinic of hospitalization were screened for all patients. RESULTS: The creatine kinase levels of the patients at admission ranged from 5052 to 59140 U/L [median 7882 U/L (IQR: 7840)]. The most frequent (23.5%) cause of admission was extremity pain. The most common reason (19.6%) in the etiology was exercise. Twenty-one patients (41.1%) were admitted to clinics, and 1 patient (1.9%) died. Acute renal failure was observed in 4 patients (8.8%). CONCLUSION: Rhabdomyolysis is a clinical syndrome that can be life-threatening owing to muscle destruction. Although it is suspected after a traumatic injury, it should also be considered when other potential symptoms are observed. All clinicians should be aware of its common causes, diagnosis, and treatment options.
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205
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Bender J, Chew R, Lin BB, Athan E. Severe Rhabdomyolysis Associated With RSV. Open Forum Infect Dis 2017; 5:ofx273. [PMID: 29354662 PMCID: PMC5767957 DOI: 10.1093/ofid/ofx273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/20/2017] [Indexed: 01/04/2023] Open
Abstract
Severe rhabdomyolysis is associated with morbidity and mortality. We report on a previously well male who developed severe rhabdomyolysis, sepsis, and multi-organ failure. The patient made a complete recovery. Extensive microbiological testing was only positive for RSV, making this the first reported case of adult RSV-related rhabdomyolysis in the literature.
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Affiliation(s)
- James Bender
- Junior Medical Workforce, Barwon Health, Geelong, Australia
| | - Rusheng Chew
- Department of Infectious Diseases, Barwon Health, Geelong, Australia
| | - Belinda Bin Lin
- Department of Infectious Diseases, Barwon Health, Geelong, Australia
| | - Eugene Athan
- Department of Infectious Diseases, Barwon Health, Deakin University, Geelong, Australia
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206
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Huynh GA, Lee AJ. High-Intensity Atorvastatin-Induced Rhabdomyolysis in an Elderly Patient With NSTEMI: A Case Report and Review of the Literature. J Pharm Pract 2017; 30:658-662. [PMID: 27798246 DOI: 10.1177/0897190016674109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A 91-year-old male was admitted to the hospital for worsening muscle weakness, muscle pain, and unexplained soreness for the past 10 days. Four months prior to his admission, the patient had experienced a myocardial infarction and was initiated on atorvastatin 80 mg daily. Although the provider had instructed the patient to decrease the atorvastatin dose to 40 mg daily 3 months prior to admission, the patient did not adhere to the lower dose regimen until 10 days prior to hospitalization. Upon admission, the patient presented with muscle weakness and pain, a serum creatinine phosphokinase of 18 723 U/L, and a serum creatinine of 1.6 mg/dL. The atorvastatin dose was held and the patient was treated with intravenous fluids. The 2013 American College of Cardiology and American Heart Association Blood Cholesterol Practice Guidelines recommend the use of moderate-intensity statins in patients older than 75 years to prevent myopathy. However, in clinical practice, aggressive statin therapy is often prescribed for significant coronary disease. Prescribing high-intensity statins for patients with advanced age, such as this case, may increase the risk of rhabdomyolysis and other complications. This case report suggests that providers should avoid or be cautious with initiating high-intensity atorvastatin in elderly patients over 75 years to minimize the risk of rhabdomyolysis.
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Affiliation(s)
- Glen A Huynh
- 1 Thomas J. Long School of Pharmacy and Health Sciences, Pharmacy Practice Department, University of the Pacific, Stockton, CA, USA
| | - Audrey J Lee
- 1 Thomas J. Long School of Pharmacy and Health Sciences, Pharmacy Practice Department, University of the Pacific, Stockton, CA, USA.,2 Pharmacy Practice Department, San Francisco VA Medical Center, San Francisco, CA, USA
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207
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Garwood C, Sandoval CP, Wonnacott R, Sadler C, Dirkes S. Continuous Renal Replacement Therapy: Case Vignettes. AACN Adv Crit Care 2017; 28:64-73. [PMID: 28254857 DOI: 10.4037/aacnacc2017686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The most common indication for continuous renal replacement therapy (CRRT) in critically ill patients is acute kidney injury with hemodynamic instability. Typically, the patient has metabolic disturbances and potential or actual fluid overload that require intervention. Certain critical care diagnoses and/or conditions or therapies present unique CRRT management approaches. Case vignettes are used to present the unique management of CRRT in critically ill patients with rhabdomyolysis, heart failure, and respiratory failure requiring extracorporeal membrane oxygenation.
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Affiliation(s)
- Charlotte Garwood
- Charlotte Garwood is Registered Nurse 2, Medical Intensive Care Unit, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232 . Cass Piper Sandoval is Clinical Nurse Specialist, Adult Critical Care, University of California, San Francisco Medical Center, San Francisco, California. Robert Wonnacott is Senior Lead Nursing Informatics, University of Michigan Health System, Ann Arbor, Michigan. Craig Sadler is Staff Nurse, University of Michigan Health System, Ann Arbor, Michigan. Susan Dirkes is Staff Nurse, University of Michigan Health System, Ann Arbor, Michigan
| | - Cass Piper Sandoval
- Charlotte Garwood is Registered Nurse 2, Medical Intensive Care Unit, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232 . Cass Piper Sandoval is Clinical Nurse Specialist, Adult Critical Care, University of California, San Francisco Medical Center, San Francisco, California. Robert Wonnacott is Senior Lead Nursing Informatics, University of Michigan Health System, Ann Arbor, Michigan. Craig Sadler is Staff Nurse, University of Michigan Health System, Ann Arbor, Michigan. Susan Dirkes is Staff Nurse, University of Michigan Health System, Ann Arbor, Michigan
| | - Robert Wonnacott
- Charlotte Garwood is Registered Nurse 2, Medical Intensive Care Unit, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232 . Cass Piper Sandoval is Clinical Nurse Specialist, Adult Critical Care, University of California, San Francisco Medical Center, San Francisco, California. Robert Wonnacott is Senior Lead Nursing Informatics, University of Michigan Health System, Ann Arbor, Michigan. Craig Sadler is Staff Nurse, University of Michigan Health System, Ann Arbor, Michigan. Susan Dirkes is Staff Nurse, University of Michigan Health System, Ann Arbor, Michigan
| | - Craig Sadler
- Charlotte Garwood is Registered Nurse 2, Medical Intensive Care Unit, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232 . Cass Piper Sandoval is Clinical Nurse Specialist, Adult Critical Care, University of California, San Francisco Medical Center, San Francisco, California. Robert Wonnacott is Senior Lead Nursing Informatics, University of Michigan Health System, Ann Arbor, Michigan. Craig Sadler is Staff Nurse, University of Michigan Health System, Ann Arbor, Michigan. Susan Dirkes is Staff Nurse, University of Michigan Health System, Ann Arbor, Michigan
| | - Susan Dirkes
- Charlotte Garwood is Registered Nurse 2, Medical Intensive Care Unit, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232 . Cass Piper Sandoval is Clinical Nurse Specialist, Adult Critical Care, University of California, San Francisco Medical Center, San Francisco, California. Robert Wonnacott is Senior Lead Nursing Informatics, University of Michigan Health System, Ann Arbor, Michigan. Craig Sadler is Staff Nurse, University of Michigan Health System, Ann Arbor, Michigan. Susan Dirkes is Staff Nurse, University of Michigan Health System, Ann Arbor, Michigan
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208
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Carnovale C, Gentili M, Antoniazzi S, Clementi E, Radice S. Levetiracetam-induced rhabdomyolysis: Analysis of reports from the Food and Drug Administration's Adverse Event Reporting System database. Muscle Nerve 2017; 56:E176-E178. [DOI: 10.1002/mus.25972] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 06/14/2017] [Accepted: 07/03/2017] [Indexed: 01/04/2023]
Affiliation(s)
- Carla Carnovale
- Department of Biomedical and Clinical Sciences, Clinical Pharmacology Unit, ASST Fatebenefratelli-Sacco University Hospital; University of Milan; Milan Italy
| | - Marta Gentili
- Department of Biomedical and Clinical Sciences, Clinical Pharmacology Unit, ASST Fatebenefratelli-Sacco University Hospital; University of Milan; Milan Italy
| | - Stefania Antoniazzi
- Scientific Direction, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Emilio Clementi
- Department Biomedical and Clinical Sciences, Clinical Pharmacology Unit, CNR Institute of Neuroscience, Sacco University Hospital; University of Milan; Milan Italy
- Scientific Institute, IRCCS E. Medea; Bosisio Parini LC Italy
| | - Sonia Radice
- Department of Biomedical and Clinical Sciences, Clinical Pharmacology Unit, ASST Fatebenefratelli-Sacco University Hospital; University of Milan; Milan Italy
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209
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Santos JM, Andrade PV, Galleni L, Vainzof M, Sobreira CFR, Schmidt B, Oliveira ASB, Amaral JLG, Silva HCA. Idiopathic hyperCKemia and malignant hyperthermia susceptibility. Can J Anaesth 2017; 64:1202-1210. [DOI: 10.1007/s12630-017-0978-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/19/2017] [Accepted: 09/15/2017] [Indexed: 12/18/2022] Open
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210
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Odolini S, Gobbi F, Zammarchi L, Migliore S, Mencarini P, Vecchia M, di Lauria N, Schivazappa S, Sabatini T, Chianura L, Vanino E, Piacentini D, Zanotti P, Bussi A, Bartoloni A, Bisoffi Z, Castelli F. Febrile rhabdomyolysis of unknown origin in refugees coming from West Africa through the Mediterranean. Int J Infect Dis 2017; 62:77-80. [PMID: 28756023 DOI: 10.1016/j.ijid.2017.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Cases of undiagnosed severe febrile rhabdomyolysis in refugees coming from West Africa, mainly from Nigeria, has been observed since May 2014. The aim of this study was to describe this phenomenon. METHODS This was a multicentre retrospective observational study of cases of febrile rhabdomyolysis reported from May 2014 to December 2016 in 12 Italian centres. RESULTS A total of 48 cases were observed, mainly in young males. The mean time interval between the day of departure from Libya and symptom onset was 26.2 days. An average 8.3 further days elapsed before medical care was sought. All patients were hospitalized with fever and very intense muscle aches. Creatine phosphokinase, aspartate aminotransferase, and lactate dehydrogenase values were abnormal in all cases. The rhabdomyolysis was ascribed to an infective agent in 16 (33.3%) cases. In the remaining cases, the aetiology was undefined. Four out of seven patients tested had sickle cell trait. No alcohol abuse or drug intake was reported, apart from a single reported case of khat ingestion. CONCLUSIONS The long incubation period does not support a mechanical cause of rhabdomyolysis. Furthermore, viral infections such as those caused by coxsackievirus are rarely associated with such a severe clinical presentation. It is hypothesized that other predisposing conditions like genetic factors, unknown infections, or unreported non-conventional remedies may be involved. Targeted surveillance of rhabdomyolysis cases is warranted.
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Affiliation(s)
- Silvia Odolini
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy.
| | - Federico Gobbi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Lorenzo Zammarchi
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Florence, Italy; SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Paola Mencarini
- Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Marco Vecchia
- Clinica di Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nicoletta di Lauria
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Florence, Italy; SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Simona Schivazappa
- Infectious Diseases-IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Tony Sabatini
- Department of Internal Medicine, Gastroenterology and Digestive Endoscopy, Poliambulanza Hospital Clinical Institute, Brescia, Italy
| | - Leonardo Chianura
- Division of Infectious Diseases, AO Niguarda Ca' Granda Hospital, Milan, Italy
| | - Elisa Vanino
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Paola Zanotti
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | - Anna Bussi
- Clinica di Medicina Interna, Azienda Socio Sanitaria Territoriale del Garda, Manerbio (BS), Italy
| | - Alessandro Bartoloni
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Florence, Italy; SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Zeno Bisoffi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
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211
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Suzuki T, Kuroiwa T, Suzuki K, Yamada H. Bilateral brachial rhabdomyolysis caused by push-up exercise. BMJ Case Rep 2017; 2017:bcr-2016-219171. [PMID: 28500110 DOI: 10.1136/bcr-2016-219171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Taku Suzuki
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Aichi, Japan.,Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takashi Kuroiwa
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Katsuji Suzuki
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Harumoto Yamada
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Aichi, Japan
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212
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Vazquez do Campo R, Siegel J, Goldstein E, Dimberg E. Clinical Reasoning: A 45-year-old man with weakness and myalgia after orthopedic surgery. Neurology 2017; 88:e185-e189. [PMID: 28483995 DOI: 10.1212/wnl.0000000000003914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Jason Siegel
- From the Department of Neurology, Mayo Clinic Jacksonville, FL
| | - Eric Goldstein
- From the Department of Neurology, Mayo Clinic Jacksonville, FL
| | - Elliot Dimberg
- From the Department of Neurology, Mayo Clinic Jacksonville, FL
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213
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The role of postictal laboratory blood analyses in the diagnosis and prognosis of seizures. Seizure 2017; 47:51-65. [DOI: 10.1016/j.seizure.2017.02.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 12/18/2022] Open
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214
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Rapidly Resolving Weakness Related to Hypokalemia in Patients Infected With Dengue Virus. J Clin Neuromuscul Dis 2017; 18:72-78. [PMID: 27861219 DOI: 10.1097/cnd.0000000000000140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Dengue is a mosquito-borne disease caused by arbovirus and well known for its typical fever with thrombocytopenia syndrome. Acute hypokalemic quadriparesis is a rare presentation of dengue with uncertain pathogenesis. We aim to describe the clinical and biochemical characteristics of rapidly resolving weakness related to hypokalemia in patients infected with dengue virus. METHODS A retrospective review of the records of patients with diagnosis of dengue-associated hypokalemic weakness was performed. Demography, clinical, biochemical characteristics, and outcome of the patients were recorded during acute phase of illness. RESULTS Our study cohort comprised 12 patients and all were males from urban dwelling. The median age was 34.5 years (range, 18-50). Presentation was acute onset rapidly worsening pure motor quadriparesis preceded by short lasting febrile episode. Weakness ranged from 2/5 to 4/5 on Medical Research Council (MRC) scale with generalized hyporeflexia or areflexia. The baseline serum potassium was mean ± SD (2.7 ± 0.48 mmol/L). All patients showed elevation of liver transaminases and elevated creatine phosphokinase level. Weakness improved in 24-72 hours in all patients with correction of serum potassium. CONCLUSIONS Dengue-associated acute hypokalemic paralysis is an underrecognized entity having favorable outcome. It should be suspected in patients presenting as acute pure motor quadriparesis after febrile illness in dengue endemic areas.
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215
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Cervellin G, Comelli I, Benatti M, Sanchis-Gomar F, Bassi A, Lippi G. Non-traumatic rhabdomyolysis: Background, laboratory features, and acute clinical management. Clin Biochem 2017; 50:656-662. [PMID: 28235546 DOI: 10.1016/j.clinbiochem.2017.02.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 12/11/2022]
Abstract
Rhabdomyolysis is a relatively rare condition, but its clinical consequences are frequently dramatic in terms of both morbidity and mortality. Although no consensus has been reached so far about the precise definition of this condition, the term rhabdomyolysis describes a rapid breakdown of striated, or skeletal, muscle. It is hence characterized by the rupture and necrosis of muscle fibers, resulting in release of cell degradation products and intracellular elements within the bloodstream and extracellular space. Notably, the percentage of patients with rhabdomyolysis who develop acute kidney injury, the most dramatic consequence, varies from 13% to over 50% according to both the cause and the clinical and organizational setting where they are diagnosed. Despite direct muscle injury (i.e., traumatic rhabdomyolysis) remains the most common cause, additional causes, frequently overlapping, include hypoxic, physical, chemical or biological factors. The conventional triad of symptoms includes muscle pain, weakness and dark urine. The laboratory diagnosis is essentially based on the measurement of biomarkers of muscle injury, being creatine kinase (CK) the biochemical "gold standard" for diagnosis, and myoglobin the "gold standard" for prognostication, especially in patients with non-traumatic rhabdomyolysis. The essential clinical management in the emergency department is based on a targeted intervention to manage the underlying cause, combined with infusion of fluids and eventually sodium bicarbonate. We will present and discuss in this article the pathophysiological and clinical features of non-traumatic rhabdomyolysis, focusing specifically on Emergency Department (ED) management.
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Affiliation(s)
| | - Ivan Comelli
- Emergency Department, Academic Hospital of Parma, Parma, Italy
| | - Mario Benatti
- Emergency Department, Academic Hospital of Parma, Parma, Italy
| | - Fabian Sanchis-Gomar
- NYU Langone Medical Center, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, USA; Department of Physiology, Faculty of Medicine, University of Valencia and Fundación Investigación Hospital Clínico Universitario de Valencia, Instituto de Investigación INCLIVA, Valencia, Spain
| | - Antonella Bassi
- Laboratory of Clinical Chemistry and Hematology, University Hospital of Verona, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Chemistry, University of Verona, Verona, Italy
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216
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Caroline P, Marie-Cécile N, Demet Y, Francis V. Case Report: Red Urine After Day Care Strabismus Surgery. ACTA ACUST UNITED AC 2017; 8:75-77. [PMID: 28045721 DOI: 10.1213/xaa.0000000000000430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In the absence of surgery on the urinary tract, the emission of red urine after anesthesia should be considered as a diagnostic emergency because it can be a sign of hematuria, hemoglobinuria, blood transfusion reaction, significant myoglobinuria, or porphyria.This case describes the management of a 12-year-old boy who presented red urine at the day care unit after strabismus surgery.
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Affiliation(s)
- Pregardien Caroline
- *Departments of Anesthesiology, Paediatric Neurology and Ophtalmology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; and †Department of Anesthesiology, Hôpital Jeanne de Flandre, Lille, France
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217
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Gurney M, Cotter TG, Wittich CM. 28-Year-Old Woman With Malaise, Cough, Myalgia, and Dark Urine. Mayo Clin Proc 2017; 92:e1-e5. [PMID: 28062066 DOI: 10.1016/j.mayocp.2016.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/22/2016] [Accepted: 03/25/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Mark Gurney
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Thomas G Cotter
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Christopher M Wittich
- Advisor to residents and Consultant in General Internal Medicine, Mayo Clinic, Rochester, MN.
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218
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Tabata S, Suzuki Y, Azuma K, Matsumoto H. Rhabdomyolysis After Performing Blood Flow Restriction Training: A Case Report. J Strength Cond Res 2016; 30:2064-8. [PMID: 26677831 DOI: 10.1519/jsc.0000000000001295] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Tabata, S, Suzuki, Y, Azuma, K, and Matsumoto, H. Rhabdomyolysis after performing blood flow restriction training: a case report. J Strength Cond Res 30(7): 2064-2068, 2016-Rhabdomyolysis is a serious and potentially life-threatening condition related to resistance training. Despite numerous reports of low-intensity blood flow restriction (BFR) training inducing muscle hypertrophy and increasing strength, few reports of rhabdomyolysis related to BFR training have been published. Here, we report a 30-year-old obese Japanese man admitted to our hospital the day after his first BFR training session with complaints of severe muscle pain in his upper and lower extremities, high fever, and pharyngeal pain. He was diagnosed with acute rhabdomyolysis based on a serum creatine phosphokinase level of 56,475 U·L and a urine myoglobin level of >3,000 ng·ml, and with acute tonsillitis based on a white blood cell count of 17,390 and C-reactive protein level of 10.43 mg·dl. A number of factors are suspected to be related to the onset and exacerbation of rhabdomyolysis, including excessive muscular training with BFR, bacterial infection, and medication. After 10 days of hospitalization with intravenous fluids and antibacterial drugs, he recovered without complications. This case indicates that BFR training should be conducted with careful consideration of the physical condition and strength of the individual to prevent serious complications, such as rhabdomyolysis.
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Affiliation(s)
- Shogo Tabata
- 1Institute for Integrated Sports Medicine, School of Medicine, Keio University, Tokyo, Japan; and 2Department of Internal Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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219
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Jeong Y, Kweon HJ, Oh EJ, Ahn AL, Choi JK, Cho DY. Exertional Rhabdomyolysis after Spinning. Korean J Fam Med 2016; 37:356-358. [PMID: 27900075 PMCID: PMC5122669 DOI: 10.4082/kjfm.2016.37.6.356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 03/27/2016] [Accepted: 03/28/2016] [Indexed: 01/04/2023] Open
Abstract
Any strenuous muscular exercise may trigger rhabdomyolysis. We report an episode of clinically manifested exertional rhabdomyolysis due to stationary cycling, commonly known as spinning. Reports of spinning-related rhabdomyolysis are rare in the English literature, and the current case appears to be the first such case reported in South Korea. A previously healthy 21-year-old Asian woman presented with severe thigh pain and reddish-brown urinary discoloration 24–48 hours after attending a spinning class at a local gymnasium. Paired with key laboratory findings, her symptoms were suggestive of rhabdomyolysis. She required hospital admission to sustain renal function through fluid resuscitation therapy and fluid balance monitoring. Because exertional rhabdomyolysis may occur in any unfit but otherwise healthy individual who indulges in stationary cycling, the potential health risks of this activity must be considered.
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Affiliation(s)
- Youjin Jeong
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hyuk-Jung Kweon
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Eun-Jung Oh
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Ah-Leum Ahn
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae-Kyung Choi
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Dong-Yung Cho
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
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Rhabdomyolysis in a Hospitalized 16-Year-Old Boy: A Rarely Reported Underlying Cause. Case Rep Pediatr 2016; 2016:7873813. [PMID: 27895953 PMCID: PMC5118508 DOI: 10.1155/2016/7873813] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/20/2016] [Indexed: 01/04/2023] Open
Abstract
Rhabdomyolysis can occur because of multiple causes and account for 7% of all cases of acute kidney injury annually in the United States. Identification of specific cause can be difficult in many cases where multiple factors could potentially cause rhabdomyolysis. We present a case of 16-year-old male who had seizures and was given levetiracetam that resulted in rhabdomyolysis. This side effect has been rarely reported previously and like in our case diagnosis may be delayed.
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221
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Faber ES, Gavini M, Ramirez R, Sadovsky R. Rhabdomyolysis After Coadministration of Atorvastatin and Sacubitril/Valsartan (Entresto™) in a 63-Year-Old Woman. DRUG SAFETY - CASE REPORTS 2016; 3:14. [PMID: 27804100 PMCID: PMC5089965 DOI: 10.1007/s40800-016-0036-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A 63-year-old woman previously stable on a regimen of atorvastatin 40 mg daily, carvedilol 25 mg twice daily, digoxin 0.125 mg daily, furosemide 40 mg daily, spironolactone 25 mg daily, rivaroxaban 15 mg daily, and enalapril 20 mg twice daily for heart failure developed rhabdomyolysis 26 days after enalapril was stopped and sacubitril/valsartan (Entresto™) started. The patient received sacubitril/valsartan at 24/26 mg twice daily for heart failure; however, after 26 days she developed muscle and skin pain. Investigations revealed elevated creatine kinase and liver function tests, and rhabdomyolysis with raised transaminases was diagnosed. Sacubitril/valsartan and atorvastatin were discontinued and the patient was hydrated. She returned to baseline in 23 days and has not had any reoccurrence of rhabdomyolysis and elevated transaminases for 46 days. A Naranjo assessment score of 5 was obtained, indicating a probable relationship between the patient's rhabdomyolysis and her use of sacubitril/valsartan. The Drug Interaction Probability Scale score was 3, consistent with a possible interaction as a cause for the reaction, with sacubitril/valsartan as the precipitant drug and atorvastatin as the object drug.
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Affiliation(s)
- Eve S Faber
- Department of Family Medicine, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Suite B, Brooklyn, NY, 11203, USA.
| | - Madhavi Gavini
- Department of Family Medicine, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Suite B, Brooklyn, NY, 11203, USA
| | - Ronald Ramirez
- Department of Family Medicine, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Suite B, Brooklyn, NY, 11203, USA
| | - Richard Sadovsky
- Department of Family Medicine, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Suite B, Brooklyn, NY, 11203, USA
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222
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Fardal H, Gøransson LG. [Exercise-induced rhabdomyolysis - a new trend?]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:1537-1541. [PMID: 27731597 DOI: 10.4045/tidsskr.16.0042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate whether or not there has been an increase in the number of admissions for exercise-induced rhabdomyolysis at Stavanger University Hospital (SUS) in recent years. MATERIAL AND METHOD The study is a retrospective review of patients discharged over the period January 2010 to March 2015 with a diagnosis of exercise-induced rhabdomyolysis and with maximum creatine kinase (CK) levels more than ten times the upper reference limit. RESULTS A total of 33 patients, 21 women and 12 men, with a median age of 28 years (18 - 68), were included in the study. Of the 33 patients, three quarters (25) were admitted in 2014 - 15, compared with eight over the period 2010 - 13. One patient developed kidney failure that required dialysis. The treatment depended more on the attending physician and department than on the patient's clinical condition and CK-level, but this did not seem to affect the rate of complications. INTERPRETATION The incidence of exercise-induced rhabdomyolysis at SUS increased from autumn 2014, and this coincided with increased media attention and a new exercise trend. We recommend standardising the treatment of exercise-induced rhabdomyolysis, as current treatment recommendations are based on rhabdomyolysis triggered by causes other than exercise.
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Scalco RS, Snoeck M, Quinlivan R, Treves S, Laforét P, Jungbluth H, Voermans NC. Exertional rhabdomyolysis: physiological response or manifestation of an underlying myopathy? BMJ Open Sport Exerc Med 2016; 2:e000151. [PMID: 27900193 PMCID: PMC5117086 DOI: 10.1136/bmjsem-2016-000151] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 12/14/2022] Open
Abstract
Exertional rhabdomyolysis is characterised by muscle breakdown associated with strenuous exercise or normal exercise under extreme circumstances. Key features are severe muscle pain and sudden transient elevation of serum creatine kinase (CK) levels with or without associated myoglobinuria. Mild cases may remain unnoticed or undiagnosed. Exertional rhabdomyolysis is well described among athletes and military personnel, but may occur in anybody exposed to unaccustomed exercise. In contrast, exertional rhabdomyolysis may be the first manifestation of a genetic muscle disease that lowers the exercise threshold for developing muscle breakdown. Repeated episodes of exertional rhabdomyolysis should raise the suspicion of such an underlying disorder, in particular in individuals in whom the severity of the rhabdomyolysis episodes exceeds the expected response to the exercise performed. The present review aims to provide a practical guideline for the acute management and postepisode counselling of patients with exertional rhabdomyolysis, with a particular emphasis on when to suspect an underlying genetic disorder. The pathophysiology and its clinical features are reviewed, emphasising four main stepwise approaches: (1) the clinical significance of an acute episode, (2) risks of renal impairment, (3) clinical indicators of an underlying genetic disorders and (4) when and how to recommence sport activity following an acute episode of rhabdomyolysis. Genetic backgrounds that appear to be associated with both enhanced athletic performance and increased rhabdomyolysis risk are briefly reviewed.
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Affiliation(s)
- Renata S Scalco
- MRC Centre for Neuromuscular Diseases , Institute of Neurology, University College London , London , UK
| | - Marc Snoeck
- MH-investigation Unit, Department of Anesthesia , Canisius-Wilhelmina Hospital , Nijmegen , The Netherlands
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases , Institute of Neurology, University College London , London , UK
| | - Susan Treves
- Departments of Anesthesia and of Biomedicine, Basel University Hospital, Basel, Switzerland; Department of Life Sciences, General Pathology Section, University of Ferrara, Ferrara, Italy
| | - Pascal Laforét
- Institut de Myologie, Hôpital Pitié-Salpêtrière , Paris , France
| | - Heinz Jungbluth
- Department of Paediatric Neurology-Neuromuscular Service, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK; Randall Division of Cell and Molecular Biophysics, Muscle Signalling Section, London, UK; Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Nicol C Voermans
- Department of Neurology , Radboud University Medical Centre , Nijmegen , The Netherlands
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224
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Nishikawa A, Mitsuhashi S, Miyata N, Nishino I. Targeted massively parallel sequencing and histological assessment of skeletal muscles for the molecular diagnosis of inherited muscle disorders. J Med Genet 2016; 54:104-110. [DOI: 10.1136/jmedgenet-2016-104073] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/28/2016] [Accepted: 08/08/2016] [Indexed: 01/04/2023]
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225
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Kim J, Lee J, Kim S, Ryu HY, Cha KS, Sung DJ. Exercise-induced rhabdomyolysis mechanisms and prevention: A literature review. JOURNAL OF SPORT AND HEALTH SCIENCE 2016; 5:324-333. [PMID: 30356493 PMCID: PMC6188610 DOI: 10.1016/j.jshs.2015.01.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 10/26/2014] [Accepted: 01/26/2015] [Indexed: 05/27/2023]
Abstract
Exercise-induced rhabdomyolysis (exRML), a pathophysiological condition of skeletal muscle cell damage that may cause acute renal failure and in some cases death. Increased Ca2+ level in cells along with functional degradation of cell signaling system and cell matrix have been suggested as the major pathological mechanisms associated with exRML. The onset of exRML may be exhibited in athletes as well as in general population. Previous studies have reported that possible causes of exRML were associated with excessive eccentric contractions in high temperature, abnormal electrolytes balance, and nutritional deficiencies possible genetic defects. However, the underlying mechanisms of exRML have not been clearly established among health professionals or sports medicine personnel. Therefore, we reviewed the possible mechanisms and correlated prevention of exRML, while providing useful and practical information for the athlete and general exercising population.
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Affiliation(s)
- Jooyoung Kim
- Health and Rehabilitation Major, College of Physical Education, Kookmin University, Seoul 136-702, Republic of Korea
| | - Joohyung Lee
- Health and Rehabilitation Major, College of Physical Education, Kookmin University, Seoul 136-702, Republic of Korea
| | - Sojung Kim
- Department of Physical Education, Global Campus, Kyung Hee University, Suwon 446-701, Republic of Korea
| | - Ho Young Ryu
- Division of Sport Science, College of Science and Technology, Konkuk University, Choong-Ju 380-702, Republic of Korea
| | - Kwang Suk Cha
- Division of Sport Science, College of Science and Technology, Konkuk University, Choong-Ju 380-702, Republic of Korea
| | - Dong Jun Sung
- Division of Sport Science, College of Science and Technology, Konkuk University, Choong-Ju 380-702, Republic of Korea
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226
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Schulman KL, Lamerato LE, Dalal MR, Sung J, Jhaveri M, Koren A, Mallya UG, Foody JM. Development and Validation of Algorithms to Identify Statin Intolerance in a US Administrative Database. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:852-860. [PMID: 27712714 DOI: 10.1016/j.jval.2016.03.1858] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 02/19/2016] [Accepted: 03/19/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To develop and validate algorithms to define statin intolerance (SI) in an administrative database using electronic medical records (EMRs) as the reference comparison. METHODS One thousand adults with one or more qualifying changes in statin therapy and one or more previous diagnoses of hyperlipidemia, hypercholesterolemia, or mixed dyslipidemia were identified from the Henry Ford Health System administrative database. Data regarding statin utilization, comorbidities, and adverse effects were extracted from the administrative database and corresponding EMR. Patients were stratified by cardiovascular (CV) risk. SI was classified as absolute intolerance or titration intolerance on the basis of changes in statin utilization and/or the occurrence of adverse effects and laboratory testing for creatine kinase. Measures of concordance (Cohen's kappa [κ]) and accuracy (sensitivity, specificity, positive predictive value [PPV], and negative predictive value) were calculated for the administrative database algorithms. RESULTS Half of the sample population was white, 52.9% were women, mean age was 60.6 years, and 35.7% were at high CV risk. SI was identified in 11.5% and 14.0%, absolute intolerance in 2.2% and 3.1%, and titration intolerance in 9.7% and 11.8% of the patients in the EMR and the administrative database, respectively. The algorithm identifying any SI had substantial concordance (κ = 0.66) and good sensitivity (78.1%), but modest PPV (64.0%). The titration intolerance algorithm performed better (κ = 0.74; sensitivity 85.4%; PPV 70.1%) than the absolute intolerance algorithm (κ = 0.40; sensitivity 50%; PPV 35.5%) and performed best in the high CV-risk group (n = 353), with robust concordance (κ = 0.73) and good sensitivity (80.9%) and PPV (75.3%). CONCLUSIONS Conservative but comprehensive algorithms are available to identify SI in administrative databases for application in real-world research. These are the first validated algorithms for use in administrative databases available to decision makers.
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Affiliation(s)
| | | | | | | | | | | | | | - JoAnne M Foody
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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227
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Potential factors involved in the causation of rhabdomyolysis following status asthmaticus. Allergy Asthma Clin Immunol 2016; 12:43. [PMID: 27555875 PMCID: PMC4994408 DOI: 10.1186/s13223-016-0149-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 08/09/2016] [Indexed: 12/18/2022] Open
Abstract
Rhabdomyolysis is a rare but potentially fatal complication of status asthmaticus. Since the first case was reported in 1978, only a few dozen cases have been described till date. We performed a literature review with the aim to characterize the pathophysiological basis of the occurrence of rhabdomyolysis in patients with status asthmaticus. Excessive exertion of respiratory muscles, hypoxia and acidosis, electrolyte imbalance, infections, some drugs used for asthma control, use of mechanical ventilation, prolonged cardiopulmonary resuscitation, higher age of the patient and some underlying diseases or genetic factors appear to be involved in its causation. In patients with status asthmaticus, it is important to pay more attention to these factors and to closely monitor creatine kinase levels in blood so as to ensure early detection of rhabdomyolysis.
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228
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73-jähriger Patient mit Kraftlosigkeit in den Extremitäten. Internist (Berl) 2016; 57:815-8. [DOI: 10.1007/s00108-016-0060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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229
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Stornelli N, Wydra FB, Mitchell JJ, Stahel PF, Fabbri S. The dangers of lithotomy positioning in the operating room: case report of bilateral lower extremity compartment syndrome after a 90-minutes surgical procedure. Patient Saf Surg 2016; 10:18. [PMID: 27462369 PMCID: PMC4960854 DOI: 10.1186/s13037-016-0106-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/12/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lower extremity acute compartment syndrome after gynecologic surgery in the lithotomy position is a rare, yet potentially devastating complication. A high level of suspicion is paramount for early recognition and mitigation of acute compartment syndrome originating from prolonged surgery in lithotomy position. CASE PRESENTATION A 23-year-old female, gravida 1, para 0, underwent a laparoscopic salpingectomy for a ruptured ectopic pregnancy. Surgical time was 90 min. Postoperatively, the patient developed acute compartment syndrome of both legs necessitating emergent bilateral four-compartment fasciotomies, with repeated returns to the operating room for 2nd look procedures and delayed wound closures. The patient regained full function within 3 months and returned to an unrestricted baseline activity level. CONCLUSION Technical diligence in applying a lithotomy position is paramount for preventing postoperative lower extremity compartment syndrome. A high level of suspicion for this severe complication in conjunction with early recognition and immediate surgical management can mitigate long-term adverse sequelae and improve postoperative outcomes.
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Affiliation(s)
- Nicole Stornelli
- Department of Obstetrics and Gynecology, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204 USA
| | - Frank B Wydra
- Department of Orthopaedic Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204 USA
| | - Justin J Mitchell
- Department of Orthopaedic Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204 USA
| | - Philip F Stahel
- Department of Orthopaedic Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204 USA
| | - Stefka Fabbri
- Department of Obstetrics and Gynecology, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204 USA
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Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:135. [PMID: 27301374 PMCID: PMC4908773 DOI: 10.1186/s13054-016-1314-5] [Citation(s) in RCA: 251] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Rhabdomyolysis is a clinical syndrome that comprises destruction of skeletal muscle with outflow of intracellular muscle content into the bloodstream. There is a great heterogeneity in the literature regarding definition, epidemiology, and treatment. The aim of this systematic literature review was to summarize the current state of knowledge regarding the epidemiologic data, definition, and management of rhabdomyolysis. Methods A systematic search was conducted using the keywords “rhabdomyolysis” and “crush syndrome” covering all articles from January 2006 to December 2015 in three databases (MEDLINE, SCOPUS, and ScienceDirect). The search was divided into two steps: first, all articles that included data regarding definition, pathophysiology, and diagnosis were identified, excluding only case reports; then articles of original research with humans that reported epidemiological data (e.g., risk factors, common etiologies, and mortality) or treatment of rhabdomyolysis were identified. Information was summarized and organized based on these topics. Results The search generated 5632 articles. After screening titles and abstracts, 164 articles were retrieved and read: 56 articles met the final inclusion criteria; 23 were reviews (narrative or systematic); 16 were original articles containing epidemiological data; and six contained treatment specifications for patients with rhabdomyolysis. Conclusion Most studies defined rhabdomyolysis based on creatine kinase values five times above the upper limit of normal. Etiologies differ among the adult and pediatric populations and no randomized controlled trials have been done to compare intravenous fluid therapy alone versus intravenous fluid therapy with bicarbonate and/or mannitol.
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231
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An Unusual Presentation of Rhabdomyolysis in a Newly Diagnosed Sjögren's Syndrome Associated Polymyositis. Arch Rheumatol 2016; 31:281-283. [PMID: 29900949 DOI: 10.5606/archrheumatol.2016.5740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/10/2016] [Indexed: 01/04/2023] Open
Abstract
Rhabdomyolysis is a serious and potentially life-threatening syndrome due to rapid breakdown of skeletal muscle fibers. Acquired and genetic causes should be investigated when patients present with rhabdomyolysis. In this article, we report a patient of polymyositis associated with Sjögren's syndrome, inducing rhabdomyolysis.
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232
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Jiang W, Wang X, Zhou S. Rhabdomyolysis induced by antiepileptic drugs: characteristics, treatment and prognosis. Expert Opin Drug Saf 2016; 15:357-65. [DOI: 10.1517/14740338.2016.1139572] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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233
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Lahoria R, Milone M. Rhabdomyolysis featuring muscular dystrophies. J Neurol Sci 2016; 361:29-33. [DOI: 10.1016/j.jns.2015.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/09/2015] [Accepted: 12/08/2015] [Indexed: 12/13/2022]
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234
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Ke CY, Yang FL, Wu WT, Chung CH, Lee RP, Yang WT, Subeq YM, Liao KW. Vitamin D3 Reduces Tissue Damage and Oxidative Stress Caused by Exhaustive Exercise. Int J Med Sci 2016; 13:147-53. [PMID: 26941574 PMCID: PMC4764782 DOI: 10.7150/ijms.13746] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/06/2016] [Indexed: 12/18/2022] Open
Abstract
Exhaustive exercise results in inflammation and oxidative stress, which can damage tissue. Previous studies have shown that vitamin D has both anti-inflammatory and antiperoxidative activity. Therefore, we aimed to test if vitamin D could reduce the damage caused by exhaustive exercise. Rats were randomized to one of four groups: control, vitamin D, exercise, and vitamin D+exercise. Exercised rats received an intravenous injection of vitamin D (1 ng/mL) or normal saline after exhaustive exercise. Blood pressure, heart rate, and blood samples were collected for biochemical testing. Histological examination and immunohistochemical (IHC) analyses were performed on lungs and kidneys after the animals were sacrificed. In comparison to the exercise group, blood markers of skeletal muscle damage, creatine kinase and lactate dehydrogenase, were significantly (P < 0.05) lower in the vitamin D+exercise group. The exercise group also had more severe tissue injury scores in the lungs (average of 2.4 ± 0.71) and kidneys (average of 3.3 ± 0.6) than the vitamin D-treated exercise group did (1.08 ± 0.57 and 1.16 ± 0.55). IHC staining showed that vitamin D reduced the oxidative product 4-Hydroxynonenal in exercised animals from 20.6% to 13.8% in the lungs and from 29.4% to 16.7% in the kidneys. In summary, postexercise intravenous injection of vitamin D can reduce the peroxidation induced by exhaustive exercise and ameliorate tissue damage, particularly in the kidneys and lungs.
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Affiliation(s)
- Chun-Yen Ke
- 1. Institute of Molecular Medicine and Bioengineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Fwu-Lin Yang
- 2. Intensive Care Unit, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Wen-Tien Wu
- 3. Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chen-Han Chung
- 4. Institute of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Ru-Ping Lee
- 5. Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Wan-Ting Yang
- 5. Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Yi-Maun Subeq
- 6. Department of Nursing, Tzu Chi University, Hualien, Taiwan
| | - Kuang-Wen Liao
- 1. Institute of Molecular Medicine and Bioengineering, National Chiao Tung University, Hsinchu, Taiwan
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Jaradat SA, Amayreh W, Al-Qa'qa' K, Krayyem J. Molecular analysis of LPIN1 in Jordanian patients with rhabdomyolysis. Meta Gene 2015; 7:90-4. [PMID: 26909335 PMCID: PMC4733219 DOI: 10.1016/j.mgene.2015.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/15/2015] [Accepted: 12/02/2015] [Indexed: 12/31/2022] Open
Abstract
Recessive mutations in LPIN1, which encodes a phosphatidate phosphatase enzyme, are a frequent cause of severe rhabdomyolysis in childhood. Hence, we sequenced the 19 coding exons of the gene in eight patients with recurrent hereditary myoglobinuria from four unrelated families in Jordan. The long-term goal is to facilitate molecular genetic diagnosis without the need for invasive procedures such as muscle biopsies. Three different mutations were detected, including the novel missense mutation c.2395G>C (Gly799Arg), which was found in two families. The two other mutations, c.2174G>A (Arg725His) and c.1162C>T (Arg388X), have been previously identified, and were found to cosegregate with the disease phenotype in the other two families. Intriguingly, patients homozygous for Arg725His were also homozygous for the c.1828C>T (Pro610Ser) polymorphism, and were exercise-intolerant between myoglobinuria episodes. Notably, patients homozygous for Arg388X were also homozygous for the c.2250G>C silent variant (Gly750Gly). Taken together, the data provide family-based evidence linking hereditary myoglobinuria to pathogenic variations in the C-terminal lipin domain of the enzyme. This finding highlights the functional significance of this domain in the absence of structural information. This is the first analysis of LPIN1 in myoglobinuria patients of Jordanian origin, and the fourth such analysis worldwide. LPIN1 mutations were cataloged in families with hereditary myoglobinuria. A novel missense Gly799Arg mutation was identified. Arg725His, the only other known missense mutation, was confirmed to be pathogenic. Arg388X, a known nonsense mutation, was the most common among Arabic patients. Patients exercise-intolerant between myoglobinuria episodes have a second mutation.
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Affiliation(s)
- Saied A Jaradat
- Princess Haya Biotechnology Center, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Wajdi Amayreh
- Department of Pediatrics, Metabolic Genetics Clinic, Queen Rania Al-Abdullah Children's Hospital, King Hussein Medical Centre, Amman 11855, Jordan
| | - Kefah Al-Qa'qa'
- Department of Pediatrics, Metabolic Genetics Clinic, Queen Rania Al-Abdullah Children's Hospital, King Hussein Medical Centre, Amman 11855, Jordan
| | - Jan Krayyem
- Princess Haya Biotechnology Center, Jordan University of Science and Technology, Irbid 22110, Jordan
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236
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Chen L, Cheng C, Chen B, Zhao Y, Zhang J, Wang B. Cumulative incidence and risk factors of creatine kinase elevation associated with telbivudine. Eur J Clin Pharmacol 2015; 72:235-41. [PMID: 26566799 DOI: 10.1007/s00228-015-1978-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/03/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE An increasing number of studies are reporting a high frequency of creatine kinase (CK) elevation during telbivudine therapy; however, few reports have focused on the cumulative incidence and risk factors of CK elevation. This study was performed to investigate the cumulative incidence and risk factors of CK elevation in Chinese patients treated with telbivudine. METHODS In this observational study, patients with chronic hepatitis B receiving telbivudine therapy between July 2008 and December 2013 were enrolled. The cumulative incidence of CK elevation was analyzed using the Kaplan-Meier method combined with the log rank test. Risk factors were determined using Cox proportional hazards regression models. RESULTS A total of 207 eligible patients were analyzed. The cumulative incidence of CK elevation at 12, 24, 36, 48, 60, and 72 months was 51.2 %, 68.9 %, 75.1 %, 78.1 %, 78.1 %, and 78.1 %, respectively. Multivariate analysis revealed that male and lower baseline estimated glomerular filtration rate (eGFR) were significant risk factors for CK elevation. CONCLUSIONS The cumulative incidence of CK elevation after long-term telbivudine use is quite high, and gender and baseline eGFR may be useful predictors. However, when combined with regular monitoring of CK levels, especially for patients with lower eGFR, telbivudine is a relatively safe nucleoside analog treatment for chronic hepatitis B.
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Affiliation(s)
- Li Chen
- Department of Pharmacy, HuaShan Hospital, Fudan University, No. 12 Middle Wu Lu Mu Qi Road, Shanghai, 200040, China
| | - Cai Cheng
- College of Pharmacy, Fudan University, Shanghai, China
| | - Bicui Chen
- Department of Pharmacy, HuaShan Hospital, Fudan University, No. 12 Middle Wu Lu Mu Qi Road, Shanghai, 200040, China
| | - Yue Zhao
- Department of Pharmacy, HuaShan Hospital, Fudan University, No. 12 Middle Wu Lu Mu Qi Road, Shanghai, 200040, China
| | - Jiming Zhang
- Department of Infectious Diseases, HuaShan Hospital, Fudan University, No. 12 Middle Wu Lu Mu Qi Road, Shanghai, 200040, China.
| | - Bin Wang
- Department of Pharmacy, HuaShan Hospital, Fudan University, No. 12 Middle Wu Lu Mu Qi Road, Shanghai, 200040, China.
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237
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[(Very) high Creatinkinase concentration after exertional whole-body electromyostimulation application: health risks and longitudinal adaptations]. Wien Med Wochenschr 2015; 165:427-35. [PMID: 26498468 DOI: 10.1007/s10354-015-0394-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 09/24/2015] [Accepted: 10/01/2015] [Indexed: 01/04/2023]
Abstract
Due to its individualization, time-efficiency and effectiveness Whole-body-Electromyo-stimulation (WB-EMS) becomes increasingly popular. However, recently (very) high Creatin-kinase concentration were reported, at least after initial WB-EMS-application. Thus, the aim of the study was to determine (1) WB-EMS induced increases of CK-concentration, (2) their impact on corresponding health parameters and (3) training-induced changes of CK-levels.Twenty-six healthy, sportive volunteers without previous experience with WB-EMS were included. Initial high intense WB-EMS application (bipolar, 85 Hz; 350 ms; intermittent, 20 min) led to an increase of the CK-level by the 117fold (28.545 ± 33.611 IU/l) of baseline. CK-peaks were detected after 72-96 h. Despite this pronounced "exertional rhabdomyolysis", we did not determine rhabdomyolysis-induced complications (e.g. acute renal failure, hyperkalemia, hypocalcaemia). After 10 weeks of WB-EMS (1 session/week) CK-reaction to intensive WB-EMS-Application was significantly blunted (906 ± 500 IE/l) and averaged in the area of conventional resistance exercise.In summary, intensity of WB-EMS should be carefully increased during the initial sessions.
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238
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Rhabdomyolysis due to Trimethoprim-Sulfamethoxazole Administration following a Hematopoietic Stem Cell Transplant. Case Rep Oncol Med 2015; 2015:619473. [PMID: 26557399 PMCID: PMC4628682 DOI: 10.1155/2015/619473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/25/2015] [Accepted: 10/04/2015] [Indexed: 01/04/2023] Open
Abstract
Rhabdomyolysis, a syndrome of muscle necrosis, is a life-threatening event. Here we describe the case of a patient with chronic myeloid leukemia who underwent a haploidentical stem cell transplant and subsequently developed rhabdomyolysis after beginning trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis therapy. Rechallenge with TMP/SMX resulted in a repeat episode of rhabdomyolysis and confirmed the association. Withdrawal of TMP/SMX led to sustained normalization of creatine kinase levels in the patient. A high index of suspicion is necessary to identify TMP/SMX as the cause of rhabdomyolysis in immunocompromised patients.
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239
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Bäumer D, Hammans S. An overview of muscle diseases presenting in adulthood. Br J Hosp Med (Lond) 2015; 76:576-82. [DOI: 10.12968/hmed.2015.76.10.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients with muscle disease present not only to neurologists, but also to rheumatologists and general physicians. This article provides a framework of how to approach patients with suspected muscle disease, and reviews the clinical features of the most frequently encountered acquired and genetic conditions in adult practice.
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Affiliation(s)
| | - Simon Hammans
- Consultant Neurologist at the Wessex Neurological Centre, University Hospital Southampton, Southampton SO16 6YD
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240
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Pariser JJ, Pearce SM, Patel SG, Anderson BB, Packiam VT, Shalhav AL, Bales GT, Smith ND. Rhabdomyolysis After Major Urologic Surgery: Epidemiology, Risk Factors, and Outcomes. Urology 2015; 85:1328-32. [PMID: 26099878 DOI: 10.1016/j.urology.2015.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 03/19/2015] [Accepted: 03/23/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To study the epidemiology, risk factors, and outcomes of rhabdomyolysis (RM) after major urologic surgery. MATERIALS AND METHODS The National Inpatient Sample (2003-2011) was used to identify patients who underwent radical prostatectomy, radical or partial nephrectomy, or radical cystectomy. Demographics included age, sex, race, and comorbidities. Factors examined included bleeding, hospital teaching status, minimally invasive technique, and development of RM. Multivariate logistic regression was used to identify independent risk factors of RM. Outcomes of mortality, acute kidney injury (AKI), length of stay, and charges in patients with RM were compared with those of controls. RESULTS A weighted population of 1,016,074 patients was identified with 870 (0.1%) developing RM, which was significantly more likely for radical or partial nephrectomy and radical cystectomy patients compared with radical prostatectomy patients. On multivariate analysis, independent risk factors for RM included younger age, male sex, diabetes, chronic kidney disease, obesity, and bleeding. Race, minimally invasive technique, and teaching status were not associated with RM when controlling for other factors. Patients with RM experienced increases in mortality, AKI, length of stay, and hospital charges. CONCLUSION Rhabdomyolysis is a rare complication after urologic surgery. Risk factors include male sex, younger age, diabetes, chronic kidney disease, obesity, and perioperative bleeding. Patients who develop RM have a higher risk of AKI, mortality, prolonged hospital stay, and increased charges.
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Affiliation(s)
- Joseph J Pariser
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL.
| | - Shane M Pearce
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
| | - Sanjay G Patel
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
| | - Blake B Anderson
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
| | - Vignesh T Packiam
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
| | - Arieh L Shalhav
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
| | - Gregory T Bales
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
| | - Norm D Smith
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL
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241
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The Contemporary Incidence and Sequelae of Rhabdomyolysis Following Extirpative Renal Surgery: A Population Based Analysis. J Urol 2015; 195:399-405. [PMID: 26321407 DOI: 10.1016/j.juro.2015.08.084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE We evaluate the contemporary incidence and consequences of postoperative rhabdomyolysis after extirpative renal surgery. MATERIALS AND METHODS We conducted a population based, retrospective cohort study of patients who underwent extirpative renal surgery with a diagnosis of a renal mass or renal cell carcinoma in the United States between 2004 and 2013. Regression analysis was performed to evaluate 90-day mortality (Clavien grade V), nonfatal major complications (Clavien grade III-IV), hospital readmission rates, direct costs and length of stay. RESULTS The final weighted cohort included 310,880 open, 174,283 laparoscopic and 69,880 robotic extirpative renal surgery cases during the 10-year study period, with 745 (0.001%) experiencing postoperative rhabdomyolysis. The presence of postoperative rhabdomyolysis led to a significantly higher incidence of 90-day nonfatal major complications (34.7% vs 7.3%, p <0.05) and higher 90-day mortality (4.4% vs 1.02%, p <0.05). Length of stay was twice as long for patients with postoperative rhabdomyolysis (incidence risk ratio 1.83, 95% CI 1.56-2.15, p <0.001). The robotic approach was associated with a higher likelihood of postoperative rhabdomyolysis (vs laparoscopic approach, OR 2.43, p <0.05). Adjusted 90-day median direct hospital costs were USD 7,515 higher for patients with postoperative rhabdomyolysis (p <0.001). Our model revealed that the combination of obesity and prolonged surgery (more than 5 hours) was associated with a higher likelihood of postoperative rhabdomyolysis developing. CONCLUSIONS Our study confirms that postoperative rhabdomyolysis is an uncommon complication among patients undergoing extirpative renal surgery, but has a potentially detrimental impact on surgical morbidity, mortality and costs. Male gender, comorbidities, obesity, prolonged surgery (more than 5 hours) and a robotic approach appear to place patients at higher risk for postoperative rhabdomyolysis.
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242
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Papadatos SS, Deligiannis G, Bazoukis G, Michelongona P, Spiliopoulou A, Mylonas S, Zissis C. Nontraumatic rhabdomyolysis with short-term alcohol intoxication - a case report. Clin Case Rep 2015; 3:769-72. [PMID: 26509002 PMCID: PMC4614635 DOI: 10.1002/ccr3.326] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 05/11/2015] [Accepted: 06/10/2015] [Indexed: 12/15/2022] Open
Abstract
Alcohol-induced rhabdomyolysis is a potentially life-threatening condition due to the probability of progression to acute renal injury. Patients admitted to emergency department with acute alcohol intoxication should always undergo blood and urine tests for early recognition and treatment of rhabdomyolysis.
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Affiliation(s)
| | | | - George Bazoukis
- Department of Internal Medicine, General Hospital of Athens "Elpis" Athens, Greece
| | | | | | - Stefanos Mylonas
- Department of Internal Medicine, General Hospital of Trikala Trikala, Greece
| | - Christos Zissis
- Department of Internal Medicine, General Hospital of Trikala Trikala, Greece
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243
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Hamel Y, Mamoune A, Mauvais FX, Habarou F, Lallement L, Romero NB, Ottolenghi C, de Lonlay P. Acute rhabdomyolysis and inflammation. J Inherit Metab Dis 2015; 38:621-8. [PMID: 25778939 DOI: 10.1007/s10545-015-9827-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 02/07/2023]
Abstract
Rhabdomyolysis results from the rapid breakdown of skeletal muscle fibers, which leads to leakage of potentially toxic cellular content into the systemic circulation. Acquired causes by direct injury to the sarcolemma are most frequent. The inherited causes are: i) metabolic with failure of energy production, including mitochondrial fatty acid ß-oxidation defects, LPIN1 mutations, inborn errors of glycogenolysis and glycolysis, more rarely mitochondrial respiratory chain deficiency, purine defects and peroxysomal α-methyl-acyl-CoA-racemase defect (AMACR), ii) structural causes with muscle dystrophies and myopathies, iii) calcium pump disorder with RYR1 gene mutations, iv) inflammatory causes with myositis. Irrespective of the cause of rhabdomyolysis, the pathology follows a common pathway, either by the direct injury to sarcolemma by increased intracellular calcium concentration (acquired causes) or by the failure of energy production (inherited causes), which leads to fiber necrosis. Rhabdomyolysis are frequently precipitated by febrile illness or exercise. These conditions are associated with two events, elevated temperature and high circulating levels of pro-inflammatory mediators such as cytokines and chemokines. To illustrate these points in the context of energy metabolism, protein thermolability and the potential benefits of arginine therapy, we focus on a rare cause of rhabdomyolysis, aldolase A deficiency. In addition, our studies on lipin-1 (LPIN1) deficiency raise the possibility that several diseases involved in rhabdomyolysis implicate pro-inflammatory cytokines and may even represent primarily pro-inflammatory diseases. Thus, not only thermolability of mutant proteins critical for muscle function, but also pro-inflammatory cytokines per se, may lead to metabolic decompensation and rhabdomyolysis.
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Affiliation(s)
- Yamina Hamel
- Institut Imagine, Institut National de la Santé et de la Recherche Médicale, Unité 1163, 75015, Paris, France
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244
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Eliakim A, Ben Zaken S, Meckel Y, Yamin C, Dror N, Nemet D. Rhabdomyolysis After Out-of-Water Exercise in an Elite Adolescent Water Polo Player Carrying the IL-6 174C Allele Single-Nucleotide Polymorphism. J Strength Cond Res 2015; 29:3506-8. [PMID: 25970495 DOI: 10.1519/jsc.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We present an adolescent elite water polo player who despite a genetic predisposition to develop exercise-induced severe muscle damage due to carrying the IL-6 174C allele single-nucleotide polymorphism, developed acute rhabdomyolysis only after a vigorous out-of-water training, suggesting that water polo training may be more suitable for genetically predisposed athletes.
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Affiliation(s)
- Alon Eliakim
- 1Child Health and Sport Center, Pediatric Department, Meir Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel; and 2Zinman College of Physical Education and Sport Sciences, Wingate Institute, Israel
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245
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Rhabdomyolysis-Associated Mutations in Human LPIN1 Lead to Loss of Phosphatidic Acid Phosphohydrolase Activity. JIMD Rep 2015; 23:113-22. [PMID: 25967228 DOI: 10.1007/8904_2015_440] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/06/2015] [Accepted: 04/08/2015] [Indexed: 12/18/2022] Open
Abstract
Rhabdomyolysis is an acute syndrome due to extensive injury of skeletal muscle. Recurrent rhabdomyolysis is often caused by inborn errors in intermediary metabolism, and recent work has suggested that mutations in the human gene encoding lipin 1 (LPIN1) may be a common cause of recurrent rhabdomyolysis in children. Lipin 1 dephosphorylates phosphatidic acid to form diacylglycerol (phosphatidic acid phosphohydrolase; PAP) and acts as a transcriptional regulatory protein to control metabolic gene expression. Herein, a 3-year-old boy with severe recurrent rhabdomyolysis was determined to be a compound heterozygote for a novel c.1904T>C (p.Leu635Pro) substitution and a previously reported genomic deletion of exons 18-19 (E766-S838_del) in LPIN1. Western blotting with patient muscle biopsy lysates demonstrated a marked reduction in lipin 1 protein, while immunohistochemical staining for lipin 1 showed abnormal subcellular localization. We cloned cDNAs to express recombinant lipin 1 proteins harboring pathogenic mutations and showed that the E766-S838_del allele was not expressed at the RNA or protein level. Lipin 1 p.Leu635Pro was expressed, but the protein was less stable, was aggregated in the cytosol, and was targeted for proteosomal degradation. Another pathogenic single amino acid substitution, lipin 1 p.Arg725His, was well expressed and retained its transcriptional regulatory function. However, both p.Leu635Pro and p.Arg725His proteins were found to be deficient in PAP activity. Kinetic analyses demonstrated a loss of catalysis rather than diminished substrate binding. These data suggest that loss of lipin 1-mediated PAP activity may be involved in the pathogenesis of rhabdomyolysis in lipin 1 deficiency.
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246
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Scalco RS, Gardiner AR, Pitceathly RD, Zanoteli E, Becker J, Holton JL, Houlden H, Jungbluth H, Quinlivan R. Rhabdomyolysis: a genetic perspective. Orphanet J Rare Dis 2015; 10:51. [PMID: 25929793 PMCID: PMC4522153 DOI: 10.1186/s13023-015-0264-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/09/2015] [Indexed: 01/19/2023] Open
Abstract
Rhabdomyolysis (RM) is a clinical emergency characterized by fulminant skeletal muscle damage and release of intracellular muscle components into the blood stream leading to myoglobinuria and, in severe cases, acute renal failure. Apart from trauma, a wide range of causes have been reported including drug abuse and infections. Underlying genetic disorders are also a cause of RM and can often pose a diagnostic challenge, considering their marked heterogeneity and comparative rarity. In this paper we review the range of rare genetic defects known to be associated with RM. Each gene has been reviewed for the following: clinical phenotype, typical triggers for RM and recommended diagnostic approach. The purpose of this review is to highlight the most important features associated with specific genetic defects in order to aid the diagnosis of patients presenting with hereditary causes of recurrent RM.
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Affiliation(s)
- Renata Siciliani Scalco
- MRC Centre for Neuromuscular Diseases and Department of Molecular Neuroscience, University College London (UCL) Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK. .,Department of Neurology, HSL, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil. .,CAPES Foundation, Ministry of Education of Brazil, Brasilia, DF, Brazil.
| | - Alice R Gardiner
- MRC Centre for Neuromuscular Diseases and Department of Molecular Neuroscience, University College London (UCL) Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.
| | - Robert Ds Pitceathly
- MRC Centre for Neuromuscular Diseases and Department of Molecular Neuroscience, University College London (UCL) Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK. .,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London (KCL), London, UK.
| | - Edmar Zanoteli
- Department of Neurology, School of Medicine, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Jefferson Becker
- Department of Neurology, HSL, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Janice L Holton
- MRC Centre for Neuromuscular Diseases and Department of Molecular Neuroscience, University College London (UCL) Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.
| | - Henry Houlden
- MRC Centre for Neuromuscular Diseases and Department of Molecular Neuroscience, University College London (UCL) Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.
| | - Heinz Jungbluth
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London (KCL), London, UK. .,Department of Paediatric Neurology, Evelina Children's Hospital, Guy's & St Thomas NHS Foundation Trust, London, UK. .,Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College London, London, UK.
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases and Department of Molecular Neuroscience, University College London (UCL) Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK. .,Dubowitz Neuromuscular Centre, Great Ormond Street Hospital, London, UK.
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247
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Olpin SE, Murphy E, Kirk RJ, Taylor RW, Quinlivan R. The investigation and management of metabolic myopathies. J Clin Pathol 2015; 68:410-7. [DOI: 10.1136/jclinpath-2014-202808] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/25/2015] [Indexed: 01/19/2023]
Abstract
Metabolic myopathies (MM) are rare inherited primary muscle disorders that are mainly due to abnormalities of muscle energy metabolism resulting in skeletal muscle dysfunction. These diseases include disorders of fatty acid oxidation, glyco(geno)lytic muscle disorders and mitochondrial respiratory chain (MRC) disease. Clinically these disorders present with a range of symptoms including infantile hypotonia, myalgia/exercise tolerance, chronic or acute muscle weakness, cramps/spasms/stiffness or episodic acute rhabdomyolysis. The precipitant may be fasting, infection, general anaesthesia, heat/cold or most commonly, exercise. However, the differential diagnosis includes a wide range of both acquired and inherited conditions and these include exposure to drugs/toxins, inflammatory myopathies, dystrophies and channelopathies. Streamlining of existing diagnostic protocols has now become a realistic prospect given the availability of second-generation sequencing. A diagnostic pathway using a ‘rhabdomyolysis’ gene panel at an early stage of the diagnostic process is proposed. Following detailed clinical evaluation and first-line investigations, some patients will be identified as candidates for McArdle disease/glycogen storage disease type V or MRC disease and these will be referred directly to the specialised services. However, for the majority of patients, second-line investigation is best undertaken through next-generation sequencing using a ‘rhabdomyolysis’ gene panel. Following molecular analysis and careful evaluation of the findings, some patients will receive a clear diagnosis. Further functional or specific targeted testing may be required in other patients to evaluate the significance of uncertain/equivocal findings. For patients with no clear diagnosis, further investigations will be required through a specialist centre.
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248
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Liewluck T, Tian X, Wong LJ, Pestronk A. Dystrophinopathy mimicking metabolic myopathies. Neuromuscul Disord 2015; 25:653-7. [PMID: 25998609 DOI: 10.1016/j.nmd.2015.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/02/2015] [Accepted: 04/04/2015] [Indexed: 12/13/2022]
Abstract
Recurrent rhabdomyolysis warrants comprehensive evaluations to search for underlying muscle diseases, including metabolic myopathies, LPIN1-myopathy, RYR1-myopathy, and less commonly muscular dystrophies. The absence of weakness and the normal or minimally elevated creatine kinase levels between attacks are typical of metabolic myopathies, LPIN1-myopathy, and RYR1-myopathy, while the presence of weakness and the highly elevated creatine kinase levels between attacks point toward muscular dystrophies. Here we report a 32-year-old man with a one-year history of recurrent rhabdomyolysis, who had normal strength, slightly elevated baseline creatine kinase level, and normal muscle histopathology. All workups for metabolic myopathies, LPIN1-myopathy and RYR1-myopathy were unrevealing. Next generation sequencing of muscular dystrophy-related genes revealed a hemizygous deletion of exons 17-34 of the dystrophin-encoding gene. Immunohistochemical study revealed absent staining for the rod domain of dystrophin. Dystrophinopathy should be considered in patients with recurrent rhabdomyolysis despite the absence of fixed weakness or highly elevated resting creatine kinase level.
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Affiliation(s)
- Teerin Liewluck
- Department of Neurology, Anschutz Medical Campus, Mail Stop B-185, 12631 East 17th Avenue, University of Colorado School of Medicine, Aurora, Colorado 80045, USA.
| | - Xia Tian
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, NAB 2015, Houston, Texas 77030, USA
| | - Lee-Jun Wong
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, NAB 2015, Houston, Texas 77030, USA
| | - Alan Pestronk
- Department of Neurology, Washington University School of Medicine, Campus Box 8111, 660 South Euclid Avenue, St. Louis, Missouri 63110, USA
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249
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Severe rhabdomyolysis associated with simvastatin and role of ciprofloxacin and amlodipine coadministration. Case Rep Nephrol 2015; 2015:761393. [PMID: 25883814 PMCID: PMC4391689 DOI: 10.1155/2015/761393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 03/19/2015] [Indexed: 01/04/2023] Open
Abstract
Simvastatin is among the most commonly used prescription medications for cholesterol reduction and the most common statin-related adverse drug reaction is skeletal muscle toxicity. Multiple factors have been shown to influence simvastatin-induced myopathy. In addition to age, gender, ethnicity, genetic predisposition, and dose, drug-drug interactions play a major role. This is particularly true for drugs that are extensively metabolized by cytochrome P450 (CYP)3A4. We describe a particularly severe case of rhabdomyolysis after the introduction of ciprofloxacin, a weak CYP3A4 inhibitor, in a patient who previously tolerated the simvastatin-amlodipine combination.
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Creatine kinase inhibits ADP-induced platelet aggregation. Sci Rep 2014; 4:6551. [PMID: 25298190 PMCID: PMC4190537 DOI: 10.1038/srep06551] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 08/11/2014] [Indexed: 02/08/2023] Open
Abstract
Bleeding risk with antiplatelet therapy is an increasing clinical challenge. However, the inter-individual variation in this risk is poorly understood. We assessed whether the level of plasma creatine kinase, the enzyme that utilizes ADP and phosphocreatine to rapidly regenerate ATP, may modulate bleeding risk through a dose-dependent inhibition of ADP-induced platelet activation. Exogenous creatine kinase (500 to 4000 IU/L, phosphocreatine 5 mM) added to human plasma induced a dose-dependent reduction to complete inhibition of ADP-induced platelet aggregation. Accordingly, endogenous plasma creatine kinase, studied in 9 healthy men (mean age 27.9 y, SE 3.3; creatine kinase 115 to 859 IU/L, median 358), was associated with reduced ADP-induced platelet aggregation (Spearman's rank correlation coefficient, -0.6; p < 0.05). After exercise, at an endogenous creatine kinase level of 4664, ADP-induced platelet aggregation was undetectable, normalizing after rest, with a concomitant reduction of creatine kinase to normal values. Thus, creatine kinase reduces ADP-induced platelet activation. This may promote bleeding, in particular when patients use platelet P2Y12 ADP receptor inhibitors.
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