Pathophysiology

Rhabdomyolysis is a syndrome characterized by injury to skeletal muscle with subsequent release of intracellular contents. These contents include myoglobin, creatine phosphokinase (CPK), aldolase, lactate dehydrogenase (LDH), serum glutamic-oxaloacetic transaminase, and potassium. Although numerous causes of rhabdomyolysis have been described, the common terminal event appears to involve the disruption of the Na +,K+-ATPase pump and calcium transport, resulting in increased intracellular calcium and subsequent muscle cell necrosis.

Several classifications systems have been developed to characterize the numerous causes of rhabdomyolysis. None of these systems are universally recognized, and each has its own limitations. In addition, many patients have multiple causes of rhabdomyolysis (e.g., alcohol abuse and hypokalemia). TabJe,..2,71-1 lists the various causes. In general, the most common causes of rhabdomyolysis appear to be alcohol and drug abuse, toxin ingestion, trauma, infection, strenuous physical activity, and heat-related illness.

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