Rhabdomyolysis: Reason for Selection and Definition
Rhabdomyolysis is the topic of today’s presentation, which is going to discuss the statistics, history, epidemiology, financial burden, physiology, etiology, diagnosis, treatment, and prognosis of the illness. The primary reason why rhabdomyolysis has been selected as the topic is the connection of this condition to the outbreak of the severe acute respiratory syndrome coronavirus two infraction, or simply COVID-19. The start of the global pandemic in Wuhan, China, has attracted a great deal of attention due to the tragic consequences of the virus’ spread. Viral infection is often an inducing factor in cases of rhabdomyolysis, which is why the number of cases of rhabdomyolysis has increased significantly since the beginning of 2020 (Jin & Tong, 2020). Rhabdomyolysis can be defined as “an interdisciplinary condition due to muscle cell injury followed by the release of cell components into circulation,” according to Stahl, Rastrelli, and Schoser (2019, p. 887).
History
In regards to history, research suggests that the first description of rhabdomyolysis is actually in the text of the Bible. Cabral et al. (2020) note that in the Book of Exodus, the entirety of the Jewish population is exposed to toxins, which cause muscle dissolution. However, the majority of the knowledge medics have about the condition currently stems from the work of Edmond Sergent (Aleckovic-Halilovic et al., 2021). In the 1940s, he managed to provide a detailed description of the case of an Algerian man suffering from rhabdomyolysis.
Statistics
As for the statistics, an estimated 25,000 cases of rhabdomyolysis are reported annually in the United States alone (Stanley et al., 2020). Research suggests that “the prevalence of acute kidney injury in rhabdomyolysis is about 5 to 30%” (Stanley et al., 2021, para. 11). The mortality rate associated with the condition is 20%, although it increases substantially up to 50% in cases of kidney injury. 30% of cases of rhabdomyolysis in children are caused by infection, which makes it the most common cause of the condition in children.
Epidemiology
The incidence of rhabdomyolysis increases in the military and among the professional athlete population due to the strenuous physical activity being one of the primary contributing factors to the development of the disease.
The incidence has grown 4-fold from 2011 to 2014 (Knafl et al., 2018). An upward trend is recognized by researchers. One of the studies found that “the frequency of presentation increased from 0.28/10,000 presentations in 2005 to 3.5/10,000 in 2015” (Knafl et al., 2018, p. 215).
Some of the most common causes of the condition are injuries, exposure to toxic substances, certain medications, overextension, as well as overconsumption of alcohol. Those at a higher risk of developing rhabdomyolysis are professional athletes, manual laborers, soldiers, firefighters, and the elderly population. The primary risk factor is the disproportionate stress on muscles, usually caused by physical activity.
Financial Costs
The financial burden of rhabdomyolysis is hard to estimate since the condition, and its various complications may lead to different consequences for each individual. It is important to mention that the cost of the electrolytes intravenous solution usually used for treatment in cases of rhabdomyolysis is around $200. This can potentially put a strain on the patient and their family. In addition, rhabdomyolysis limits an individual’s ability to participate in physical activity, which may result in the loss of productivity, affecting the company this person is an employee of.
Anatomy & Physiology/Etiology
Rhabdomyolysis is essentially caused by muscle breakdown and muscle death. The disintegration of muscle cells results in myoglobin being released into the blood. Myoglobin is a protein that a person’s kidneys are tasked with removing from the blood. In the case of rhabdomyolysis, myoglobin is not removed quickly enough from the system, which causes it to congest, resulting in the risk of kidney failure.
Diagnosis
The condition’s clinical features are not specific enough to immediately determine that every patient suffering from the symptoms typically associated with rhabdomyolysis indeed has rhabdomyolysis. Thus, healthcare staff might perform a urine dipstick test in order to determine the presence of hemoglobin or myoglobin. Therefore, doctors may use a positive test for myoglobin to confirm a patient has rhabdomyolysis. Clinicians usually regard the symptoms a patient might be dealing with in two categories: local and systemic. Local symptoms of rhabdomyolysis include muscle soreness, muscle pain, and swelling. Systemic signs are abnormally colored urine, fever, as well as nausea.
Treatment
The most common pathway in rhabdomyolysis treatment is the intravenous injection of fluids and electrolytes through an IV. The primary goal is to remove the toxins from the body, which might take a couple of days to ensure a safe recovery. Some patients might require physical therapy after the injections to strengthen their muscles. However, rhabdomyolysis can lead to severe complications. In case of kidney damage, dialysis may be required. Kidney failure prompts more extreme measures.
Prognosis
In regards to prognosis, it is important to mention it is mostly positive as the majority of patients recover smoothly, possibly experiencing only weakness and muscle soreness as a result of treatment. According to Cabral et al. (2020), the prognosis of rhabdomyolysis “is heavily dependent upon the underlying etiology and the associated comorbidities” (p. 14). However, in up to 40% of cases, patients develop acute kidney injury, which can then result in kidney failure. Fortunately, acute kidney failure is reversible in most cases, which means that the majority of patients recover successfully, although it might take them a couple of months.
Conclusion
In conclusion, rhabdomyolysis is a serious condition that demands attention as more people begin to suffer from it due to the effects of the coronavirus. The disintegration of muscle cells usually affects the elderly population and those involved in strenuous physical activity or labor on a daily basis, which includes endurance athletes, manual laborers, firefighters, and so on. Although rhabdomyolysis may lead to acute kidney injury or even kidney failure, the condition is mostly reversible. Patients may require intravenous electrolyte and fluid injections or physical therapy. In the most severe cases, dialysis might be necessary.
References
Jin, M., & Tong, Q. (2020). Rhabdomyolysis as potential late complication associated with COVID-19. Emerging Infectious Diseases, 26(7), 1618–1620. Web.
Cabral, B. M. I., Edding, S. N., Portocarrero, J. P., & Lerma, E. V. (2020). Rhabdomyolysis. Disease-a-Month, 66(8). Web.
Stahl, K., Rastelli, E., & Schoser, B. (2019). A systematic review on the definition of rhabdomyolysis. Journal of Neurology, 267, 877–882. Web.
Aleckovic-Halilovic, M., Pjanic, M., Mesic, E., Storrar, J., & Woywodt, A. (2021). From quail to earthquakes and human conflict: a historical perspective of rhabdomyolysis. Clinical Kidney, 14(4), 1088–1096. Web.
Stanley, M., Chippa, V., Aeddula, N. R., Quintanilla Rodriguez, B. S., & Adigun, R. (2021). Rhabdomyolysis. Stat Pearls. Web.
Knafl, E. G., Hughes, J. A., Dimeski, G., & Eley, R. (2018). Rhabdomyolysis: Patterns, circumstances, and outcomes of patients presenting to the emergency department. The Ochsner journal, 18(3), 215–221. Web.