A 67-year-old man with diabetes and kidney disease and renal insufficiency was found to have high triglycerides during physical examination. The community doctor asked her to add Fitter lipid-lowering drugs on the basis of statins. As a result, her whole body was in pain after ta

rhabdomyolysis, your muscles are far less robust than you think

Tianjin University TEDA Hospital | Li Qing

case

67-year-old man, diabetes nephropathy , renal insufficiency, physical examination found that the triglycerides were high, the community doctor asked her to add Bate lipid-lowering drugs on the basis of statins, and the result was pain throughout the body after taking the medication. He came to the hospital for examination urgently and found that the creatine kinase was increased by 100 times, and was diagnosed as rhabdomyolysis .

case 2

A few days ago, a friend's son was in pain after exercising, and the urine he urinated was brown. He hurried to the hospital for examination and found that the creatine kinase increased by 320 times, and was also diagnosed as rhabdomyolysis.

These are just two examples recently. In fact, this situation is not uncommon in clinical practice. The Department of Nephrology often admits patients with rhabdomyolysis. A few years ago, one day, two patients with rhabdomyolysis developed after fitness were admitted at the same time, one was 23 years old and the other was 24 years old.

Striatal muscle is also called Skeletal muscle , which is what we often call muscle. Muscles are widely distributed in the human body, with about 639 muscles in the whole body, accounting for almost 40 to 50% of the body weight, which shows the weight of muscles in the human body.

The seemingly strong muscles are actually very fragile and far less strong than we imagined.

rhabdomyolysis is, causes a large amount of rhabdomyosmiasis to be destroyed or disintegrated due to various reasons, causing a large amount of myoglobin , creatine kinase and other substances in myocytes to enter the blood circulation, causing the human body's acid and base imbalance, electrolyte disorder , and further lead to acute renal injury clinical syndrome.

The Internet often reports that rhabdomyolysis caused by excessive exercise. In fact, excessive exercise is only one of the reasons, and many reasons can lead to rhabdomyolysis. The three most common causes of are drugs, excessive exercise and alcohol. The three appear at the same time, and the incidence is higher.

. Common causes of rhabdomyolysis

1

Mechanical damage:

Over exercise, muscle squeeze injuries, beatings, electric shock injuries, status epilepsy, systemic spasm, etc. Rhabdomyolysis caused by long-distance running, barbell, fitness, sit-ups, earthquake squeezing, beating, etc. belongs to this category.

It was mentioned that this is the reason for the my friend's child's mutation, and the two young men who were hospitalized at the same time a few years ago were also the reason.

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2

Drug:

There are 6 common drugs that cause rhabdomyolysis in :

✅✅① Statin lipid-lowering drugs

1 statin causes myopathy rate of about 1.5%~5%, and the incidence rate of rhabdomyolysis syndrome is 0.04%~0.2%. Cirivastatin, which was launched in the early years, was kicked out of the market because of severe rhabdomyolysis and death of individuals. If the patient has unexplained muscle pain, tenderness or fatigue during the medication process, he/she should seek medical treatment in time.

✅②Bite lipid-lowering drugs

Commonly used Fiber drugs include fenofibrate , geffibezil, benzafibrate , clobate , etc., and their main function is to reduce triglycerides. Fate-based lipid-lowering drugs can cause myositis, myopathy and rhabdomyolysis syndrome. Patients with renal insufficiency or hyperthyroidism have an increased risk of myopathy.

✅�Qionalonolone antibacterial drugs

Commonly used quinolonone antibacterial drugs include norfloxacin , ciprofloxacin , levofloxacin , moxifloxacin , etc. Quinolone drugs can cause adverse reactions to the musculoskeletal system, manifested as arthralgia , Achilles tendonitis , tendon inflammation , tendon rupture , muscle weakness , myalgia, rhabdomyolysis, etc.

✅✣The drug that causes hypokalemia

Hypokalemia is a risk factor for rhabdomyolysis. Under normal circumstances, when muscle contracts, potassium ion enters the cell, which can increase the blood flow of the muscle. In hypokalemia, persistent muscle contraction can cause ischemia and muscle necrosis.

Many drugs that cause hypokalemia can cause muscle damage, such as furosemide, hydrochlorothiazide, amphotericin B, compound glycyrrhizine, etc.

✅✤ Psychotropic drugs

antipsychotic drugs ( chlorpromazine , pernazine , haloperidol, risperidone), antidepressants ( amitriptyline , doxepin, fluoxetine , venlafaxine ), sedative hypnosis drugs (diazepam, nizopam, lorazepam), etc., have all been reported to cause rhabdomyolysis.

psychotropic drugs cause rhabdomyolysis, which may be related to the lack of energy supply to myocytes caused by drugs or direct damage to myocytes.

✅✥ Anti-gout drug

for acute attacks of gout and analgesic colchicine is a cell mitosis inhibitor, which induces apoptosis and produces toxicity to cells. In addition to causing myocardium suppression, it can also cause myasthenia, myalgia, elevated creatine phosphate kinase, rhabdomyolysis, etc.

3

toxic and certain foods:

eats a lot of crayfish, wasp stings, snake venom, spider toxin, scorpion toxin, etc. hornet venom, part snake venom, spider venom and other toxins are induced by as a heterogeneous protein in the human body and causing muscle dissolution. As for the pathogenesis of muscle dissolution caused by eating crayfish and certain seafood, it is not very clear at present.

4

Alcohol:

At least 20% of acute rhabdomyolysis is related to alcohol consumption. Healthy people may experience asymptomatic elevation of creatine kinase and muscle lesions when drinking alcohol in large quantities. If they are taking the above drugs, rhabdomyolysis is more likely to occur. Therefore, it is not an exaggeration to say that alcohol is an accomplice of rhabdomyolysis.

It is best not to drink a lot of alcohol.

5

Hypoxia and ischemia:

Carbon monoxide poisoning leads to systemic hypoxia, and muscle ischemia necrosis is also prone to rhabdomyolysis.

6

Heat stroke, high fever, burn , long-term low temperature:

This does not need to be explained too much. dethermic that appeared in a certain marathon in the past few years belonged to this kind of situation.

. What are the manifestations of rhabdomyolysis

After the occurrence of myolysis, it mainly manifests as acute muscle pain , muscle spasm and edema, and the muscles have a "watering feeling". The symptoms of the whole body include nausea, vomiting, soy sauce urination, and even hematuria of the naked eye , etc.

test shows that myoglobin and creatine kinase in the blood are significantly increased, and creatine kinase is more than 5 times more valuable; serum creatinine , urea nitrogen, blood potassium, serum uric acid , blood phosphorus, etc. are progressively increased.

. How can muscle dissolution cause renal failure? Rhabdomyolysis occurs in

, which is not just a problem of muscle pain. It was observed that 10% to 40% of severe rhabdomyolysis will cause acute renal failure . How can myolysis lead to acute renal failure? After the myocytes are damaged, a large amount of myoglobin in the cells is released into the blood and flows to the kidneys with the blood, blocking renal tubules like impurities blocking the "floor drain", causing acute renal tubular necrosis , acute renal failure, oligouria and even anuria. A large amount of potassium ions in myocytes are also released into the blood, causing hyperkalemia .

At the same time, the human blood is redistributed during excessive exercise, and a large amount of blood is supplied to the muscles, causing the blood vessels of the kidneys to contract; exercise is accompanied by a lot of sweating, resulting in the reduction of blood volume , the kidneys are in a state of ischemia, and the kidneys are inadequate perfusion, which further aggravates kidney damage and leads to acute renal failure.

Acute renal failure induced acute heart failure and hyperkalemia are common causes of death in rhabdomyolysis.

. Prevent rhabdomyolysis,

These matters should be paid attention to

Motion rhabdomyolysis is not a new thing. It was reported abroad as early as 1970, but it did not attract enough attention from people.

Sports rhabdomyolysis does not only occur in people who exercise at once, but also in professional athletes who exercise regularly, and may even have a higher incidence. Regular strength and physical training of professional athletes often leads to rhabdomyolysis. In 2011, 13 football players at the University of Iowa sued the school for this, because the coach asked them to do 20 minutes of weight-bearing squat training, which caused rhabdomyolysis.

Now, people's health awareness is getting stronger and stronger, and the concept of exercise and fitness has entered thousands of households, which is definitely a good phenomenon. However, some people are eager to "form" , blindly increasing the intensity of exercise, or blindly conducting training for a certain project, but do not understand its exercise rules, which is unscientific and systematic. Therefore, the problems brought by exercise are becoming more and more prominent, and fitness will not be effective, which will harm health.

Health tips: Do not exercise blindly, exercise should be progressive step by step, and pay attention to timely rest when exercising. Whether to participate in a vigorously consumed exercise like a marathon, you must conduct a physical assessment and be fully prepared.

Dehydration during exercise is the cause of rhabdomyolysis. Therefore, you must fully replenish water during exercise and maintain sufficient urine volume.

Try to avoid high-intensity training under direct sunlight or in hot and humid environments; try not to exercise vigorously after having a cold and taking cold medicine; do not exercise vigorously after drinking.

Early detection, early diagnosis, and early treatment. After strenuous exercises such as marathons or long-distance running, it is best to have a physical examination.

Don't abuse drugs. drugs should be used under the guidance of a doctor, and the symptoms should be closely observed at the beginning of the medication, and problems should be checked and dealt with in a timely manner when they are found.