Discussion Question The Most Appropriate Next Step to Confirm the Diagnosis of Rhabdomyolysis in This Patient

Discussion Question The Most Appropriate Next Step to Confirm the Diagnosis of Rhabdomyolysis in This Patient

Discussion Question The Most Appropriate Next Step to Confirm the Diagnosis of Rhabdomyolysis in This Patient

The Most Appropriate Next Step to Confirm the Diagnosis of Rhabdomyolysis in This Patient

The next step to confirming rhabdomyolysis in the patient will be laboratory testing for serum levels of enzymes SGPT, SGOT, and LDH. The levels of these enzymes increase when the muscle is being destroyed in rhabdomyolysis (Stanley et al., 2021). An elevated serum of these enzymes, in addition to an elevated creatine kinase level, will confirm rhabdomyolysis.

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The Most Likely Etiology of This Patient’s Recurrent Rhabdomyolysis

The most common etiologies of rhabdomyolysis are muscle ischemia or mechanical trauma, extreme exercise, drugs and toxins, and infection from influenza A and B or Staphylococcus aureus. The patient’s recurrent rhabdomyolysis can be attributed to prolonged or strenuous exercise (Gupta et al., 2021). Fatty acid oxidation is the primary source of muscle energy in fasting, prolonged exercise, and illness. Disorders of the fatty acid oxidation pathway may have resulted in rhabdomyolysis after the patient had a prolonged exercise (Gupta et al., 2021).  Besides, the patient’s history of malaise and cough could have been due to an infection, which led to rhabdomyolysis.

Pathophysiology behind Rhabdomyolysis

Conditions necessary for normal skeletal muscle function include sufficient metabolism of adenosine triphosphate (ATP), adequate electrolyte exchange, and an intact plasma membrane of the myocytes (Gupta et al., 2021). However, in rhabdomyolysis, these conditions are altered, leading to the destruction of skeletal muscle. Skeletal muscle tissue breakdown results in the release of myocytes’ intracellular components into the plasma, including creatine kinase, myoglobin, and several electrolytes (Gupta et al., 2021). Myoglobinuria and electrolyte abnormalities contribute to end-organ complications, such as acute kidney injury.

Possible Complications of Rhabdomyolysis

Complications of rhabdomyolysis include acute kidney injury, renal failure, electrolyte abnormalities, hyperuricemia, hypoalbuminemia, and compartment syndrome (Stanley et al., 2021). Disseminated intravascular coagulation (DIC) is usually a late complication.

Medications That May Cause Rhabdomyolysis

Any drug or medication that alters the production of ATP in the skeletal muscle or elevates energy requirements may lead to rhabdomyolysis (Stanley et al., 2021). Rhabdomyolysis is associated with medications such as Ketamine hydrochloride, salicylates, statins, fibric acid derivatives, antipsychotics, anxiolytics, and amphetamines (Stanley et al., 2021). Other medications include anesthetic and paralytic agents, Aminocaproic acid, Propofol, Amphotericin B, Quinine, Corticosteroids, Colchicine, and Theophylline. Antihistamines may cause rhabdomyolysis, especially in children.

References

Gupta, A., Thorson, P., Penmatsa, K. R., & Gupta, P. (2021). Rhabdomyolysis: Revisited. Ulster Med J, 90(2), 61-69.

Stanley, M., Chippa, V., Aeddula, N. R., Rodriguez, B. S. Q., & Adigun, R. (2021). Rhabdomyolysis. StatPearls [Internet].

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please answer the questions for the scenario, 250 words minimum…

Answer all of the following questions for your discussion response.

A 28-year-old woman was admitted to the general internal medicine service with a 3-day history of malaise and cough that progressed to include myalgia, generalized weakness, and dark-colored urine. Three days before admission, she had an abrupt onset of a dry nonproductive cough, malaise, and anorexia that resulted in a prolonged period of fasting. On the second day of the illness, she awoke with diffuse muscle pain and progressive weakness, culminating in an inability to walk. She subsequently noted dark urine and presented to the emergency department, leading to this admission. She had no recent trauma, exercise, rash, joint pain, or foreign travel. She was taking a multivitamin supplement but no prescription medication.

At presentation, she was mildly distressed but oriented. Her vital signs were within normal limits, apart from mild tachycardia (heart rate, 104 beats/min). Physical examination revealed grade 3/5 limb muscle strength, although testing was associated with obvious discomfort. Muscle bulk and tone, tendon reflexes, and sensation were normal. Notably, there was no rash, and cardiorespiratory examination yielded unremarkable findings. Initial chest radiography revealed a left lower lobe infiltrate most consistent with pneumonia. Urinalysis was strongly positive for hemoglobin. Initial laboratory analysis (reference ranges provided parenthetically) revealed that her creatine kinase (CK) level was markedly elevated at 118,342 U/L (38-176 U/L).

What is the most appropriate next step to confirm the diagnosis of rhabdomyolysis in this patient? Provide an explanation for your answer.
What is the most likely etiology of this patient\’s recurrent rhabdomyolysis?
Rhabdomyolysis is a rapid breakdown of muscle. Detail the pathophysiology behind rhabdomyolysis.
What are the possible complications of rhabdomyolysis?
Which medications may cause rhabdomyolysis?