Parekh Ram, Care David A, Tainter Christopher R
Mount Sinai School of Medicine, New York, NY, USA.
Emerg Med Pract. 2012 Mar;14(3):1-15; quiz 15.
Rhabdomyolysis is a potentially life-threatening condition caused by a breakdown of skeletal muscle and the release of the intracellular contents into the circulatory system. There are many possible causes, including crush injury, excessive muscular activity, medications, infections, and varied metabolic, connective tissue, rheumatologic, and endocrine disorders. It is vital that emergency clinicians consider the diagnosis when patients present with circumstances known to be high-risk for rhabdomyolysis, including intoxication, prolonged immobilization, and/or altered mentation. Optimal crystalloid selection is still debated, but immediate, aggressive intravenous volume expansion is indicated to prevent myoglobinuric renal failure. Serum potassium levels must be obtained and electrocardiograms must be evaluated to identify life- and limb-threatening complications of hyperkalemia. This review examines the current evidence on symptoms and diagnostic methods as well as standard first-line treatments of rhabdomyolysis. In addition, evidence from animal models on urine alkalinization with sodium bicarbonate infusion is discussed.
横纹肌溶解症是一种潜在的危及生命的病症，由骨骼肌分解以及细胞内物质释放到循环系统中引起。其病因众多，包括挤压伤、过度肌肉活动、药物、感染以及各种代谢、结缔组织、风湿和内分泌疾病。当患者出现已知横纹肌溶解症高风险情况时，如中毒、长期固定不动和/或精神状态改变，急诊临床医生务必考虑该诊断。最佳晶体液的选择仍存在争议，但需立即进行积极的静脉补液以预防肌红蛋白尿性肾衰竭。必须测定血清钾水平并评估心电图，以识别高钾血症危及生命和肢体的并发症。本文综述探讨了横纹肌溶解症症状、诊断方法以及标准一线治疗的现有证据。此外，还讨论了动物模型中关于输注碳酸氢钠使尿液碱化的证据。
