The effects of muscle injuries are well known to people involved in professional sports. Those who receive constant physical activity and have an idea of their benefits and harms are familiar with the concept of “rhabdomyolysis”. Symptoms of this disease are very serious. Despite the mild course, pathology can lead to dire consequences for the body. Rhabdomyolysis - what is it? This question can be answered not only by doctors, but also by any qualified trainer in each sport. Pathology is very dangerous and in severe stages can lead to death. However, if it is detected on time, a complete cure is possible.
What is rhabdomyolysis disease?
This pathology is most often observed with muscle injuries. It involves the destruction of tissue and the release of harmful substances into the blood. So you can briefly describe the essence of the syndrome called rhabdomyolysis. What it is, it will become more clear if we study the process of development of the disease and its consequences for the body. It should be remembered that not every injury or physical exertion leads to the disease. Rhabdomyolysis is a syndrome in which the destruction of muscle tissue occurs. Due to the destruction of skeletal muscles, a substance enters the bloodstream, which normally should not be there. This is myoglobin protein. It is an essential component for muscles. Normally, it is inactivated by the kidneys and does not harm the body. But with the destruction and breakdown of muscles, its amount in the blood reaches a high concentration. As a result, myoglobin circulates throughout the body for a long time, releasing nephrotoxic free radicals. These substances are extremely harmful to the tissues of the renal tubules. Based on this, we can answer the question: "Rhabdomyolysis - what is it and why is it dangerous?" In addition to muscle damage, this syndrome can lead to such a serious condition as acute renal failure. In case of untimely assistance, the arresters can cause death.
Rhabdomyolysis: causes of the disease
There are 2 groups of causes leading to the development of rhabdomyolysis. In the first case, these are injuries of skeletal muscles. They do not include minor effects on the muscles (bruises). Among the damaging factors are:
- Severe accident.
- Large burns in area and depth (reaching the muscle layer).
- The impact of electric current on the body.
- Violence leading to muscle injuries.
- Toxicosis caused by traumatic shock.
- Long-term surgery.
Another cause of rhabdomyolysis is a strong contraction of muscle tissue. Severe physical exertion (unusual for the body), convulsive syndrome can lead to them.
In addition, there are other factors leading to rhabdomyolysis. They are less common, but can still cause the development of this pathology. These include electrolyte imbalance, bacterial and viral diseases, as well as drug intoxication. All these factors contribute to the lack of ATP. As you know, it is the deficiency of this substance that affects the development of rhabdomyolysis. A small amount of ATP causes a decrease in electrolytes in the body. These include substances such as calcium, phosphates, and potassium. The lack of these substances is observed during heat and sunstroke, hypothermia. In some cases, the destruction of muscle tissue leads to a long stay of a person in a supine position - immobilization.
The mechanism of development of rhabdomyolysis
The pathogenesis of rhabdomyolysis depends on what reason caused the destruction of skeletal muscle. If the muscles were damaged by traumatic effects or metabolic disorders, then the cells swell. This happens due to the ingress of fluid from the surrounding space into the membrane of myocytes. Due to this violation, the cells swell and become large. Altered myocytes put pressure on the surrounding tissue and nerve fibers. Thus, the flow of blood to healthy muscle cells is disrupted, which leads to their destruction. Due to the destruction of skeletal muscle, a protein is released - myoglobin. In general, this substance is not toxic to the body. However, protein can cause kidney damage. This happens as follows: myoglobin binds to a substance found in kidney cells. This compound leads to the formation of solid formations that interfere with the flow of blood. In addition, myoglobin has a nephrotoxic effect.
Clinical signs of pathology
Severe and mild symptoms of rhabdomyolysis are distinguished. In the first case, muscle destruction syndrome is combined with renal failure. Mild rhabdomyosis is not burdened by acute renal failure. The clinical manifestations of pathology include:
- Muscle weakness.
- Darkening of the color of urine. This symptom indicates impaired renal function and is a diagnostic criterion for rhabdomyolysis.
- Edema and soreness of skeletal muscles.
With the addition of renal failure , the patient's condition deteriorates sharply. Symptoms of acute renal failure include:
- Swelling of the limbs.
- Small excretion of urine, up to its absence.
- Compression Syndrome. It occurs due to swelling of muscle tissue. May cause compression of vital organs. Symptoms of this disorder are: shortness of breath, decreased blood pressure, shock.
- Tachycardia, subsequently - filiform pulse.
- Electrolyte imbalance.
- Coma.
Diagnostic criteria for rhabdomyolysis
The disease can be suspected according to the following criteria: trauma to muscle tissue, soreness and swelling of the muscles, dark urine. These symptoms suggest a preliminary diagnosis of rhabdomyolysis. The disease is always accompanied by changes in the blood and urine. The diagnosis is confirmed if, in laboratory tests, the following disorders are identified:
- Elevated levels of creatine phosphokinase.
- The appearance in the blood of myoglobin.
- Increased levels of phosphorus and potassium, decreased calcium ions.
- With the development of renal failure, a large amount of creatinine and urea.
- Myoglobinuria (the appearance of protein in the urine).
In addition, changes are observed on the ECG (expansion of the ventricular complexes, the appearance of T-waves). With severe compression syndrome, there may be damage to internal organs, bones. Therefore, to diagnose disorders, it is necessary to conduct radiography.
Treatments for rhabdomyolysis
Assistance to the patient should begin to be provided immediately, immediately after the diagnosis of rhabdomyolysis was made. Treatment of pathology should be carried out in a hospital, as in a hospital setting it is possible to monitor the level of electrolytes. To cleanse the body, rehydration is performed. In case of severe rhabdomyolysis, infusion therapy with saline is necessary. Correction of water-salt and electrolyte metabolism is also important. To normalize diuresis, diuretics “Furosemide” or “Mannitol” are administered. In extremely severe cases, hemodialysis is used. If muscle pressure reaches more than 30 mm. Hg. Art., surgical excision of tissues is necessary - fasciotomy. Only in this way can the cessation of further organ compression be achieved.
Possible complications of pathology
You should be aware that timely assistance with a mild degree of pathology will help stop rhabdomyolysis. Photos of patients suffering from these syndromes are presented in abundance on the pages of relevant medical information resources. To know how the affected muscles look is very important for people involved in heavy physical labor. If rhabdomyolysis is suspected, laboratory tests of blood and urine should be performed. If the disease has developed to a severe degree, it is dangerous with the following complications:
- Damage to organs and tissues. Occurs due to compression syndrome.
- Acute renal failure.
- DIC syndrome. Occurs due to poor blood coagulation. In severe cases, it leads to death.
The prognosis for life with rhabdomyolysis
The prognosis depends on the severity of the pathology. At the initial stage, the disease responds well to drug treatment. Relapses are observed only in case of repeated trauma. If the pathology has reached a severe degree, the prognosis is less favorable. Nevertheless, a cure is possible with a combination of drug therapy and surgery. In the case of acute renal failure, the mortality rate is 20%.