Rhabdomyolysis And Dcs
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The Iceni
Medical Moderator
Hi Francr,
I can think of no mechanism for rhabdomyolysis itself to affect the mechanisms of decompression, but the underlying cause could be problematic.
Crush injury, burn or other repeatable/ongoing cause?
I can think of no mechanism for rhabdomyolysis itself to affect the mechanisms of decompression, but the underlying cause could be problematic.
Crush injury, burn or other repeatable/ongoing cause?
Dr.,
The first time it occured was in the OR, routine ankle surgery. the person was given Succinylcholine to administer general anesthesia. Patient suffered global cramps and the procedure aborted. Patient was flushed with IV and given Dantrolene. Muscle biopsy confirmed that the patient was grossly normal for Malignant Hyperthermia (MH). Five years later, two weeks after suffering from a common cold, patient was exercising extrenously, which was routine for this patient, the patient started suffering from cramps. Patient took a break from exercises for a couple of days. After a couple of days of inactivity, patient was walking from a parking lot to his car and suddenly had severe "charlie horse" on both thighs. Patient dismissed them as Delayed Onset Muscle Syndrome (DOMS) from previous extra activities. A week later, local blood test confirmed rhabdomyolisis and of course, patient has elevated CK, not the same level as the MH episode, but still very high. Patient was given 3 li of IV and was advised not to take ibuprofen and to drink a lot of fluids and rest. Subsequent test showed Ck level going down, renal test is normal and patient suffers less frequent cramps. When the patient had the cold, patient was taking Nyquil and when the patient suffered the "charlie horses", patient took Naproxene and Flexiril.
The first time it occured was in the OR, routine ankle surgery. the person was given Succinylcholine to administer general anesthesia. Patient suffered global cramps and the procedure aborted. Patient was flushed with IV and given Dantrolene. Muscle biopsy confirmed that the patient was grossly normal for Malignant Hyperthermia (MH). Five years later, two weeks after suffering from a common cold, patient was exercising extrenously, which was routine for this patient, the patient started suffering from cramps. Patient took a break from exercises for a couple of days. After a couple of days of inactivity, patient was walking from a parking lot to his car and suddenly had severe "charlie horse" on both thighs. Patient dismissed them as Delayed Onset Muscle Syndrome (DOMS) from previous extra activities. A week later, local blood test confirmed rhabdomyolisis and of course, patient has elevated CK, not the same level as the MH episode, but still very high. Patient was given 3 li of IV and was advised not to take ibuprofen and to drink a lot of fluids and rest. Subsequent test showed Ck level going down, renal test is normal and patient suffers less frequent cramps. When the patient had the cold, patient was taking Nyquil and when the patient suffered the "charlie horses", patient took Naproxene and Flexiril.
wetvet
Guest
Hmm, that could discribe many of my posts. Just out of curiosity, what is the suspected cause of rhabdomyolisis in humans? It is a HUGE, and often fatal problem in athletic horses.....they are awful to encounter, with about 700 pounds of cramped muscles. In horses a calcium channel block is suspected, but AFAIK is unproven. Also interesting that the patient was given succinol CoA.....using SCA is frowned upon in vet med, since in the old days SCA used to be used as sole "anesthesia" during horse castrations. Sorry to blather about unrelated stuff.....
Wetvet
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I'm not familiar with succinol CoA, but neuromuscular blockers such as succinylcholine are sometimes used as an adjuvant in human surgical anesthesia.
Ouch, but it hurts to even think of equine castration solely under such a drug.
In any event, here are some causes of rhabdomyolisis:
1 : Inherited causes of rhabdomyolysis. Poels & Gabreels
(1993) Clin Neurol Neurosurg 95 : 175-192.
Deficiencies of glyco(geno)lytic enzymes
myophosphorylase (McArdle's disease)
phosphorylase kinase
phosphofructokinase (Tarui's disease)
phosphoglycerate mutase
phosphoglycerate kinase
lactate dehydrogenase
Abnormal Lipid Metabolism
carnitine palmitoyltranferase deficiency I and II
carnitine deficiency
Other genetic disorders
idiopathic rhabdomyolysis
myoadenylate deaminase deficiency
malignant hyperthermia
neuroleptic malignant syndrome
Acquired causes may be divided into traumatic, ischaemic, metabolic, infectious, inflammatory, and toxic groups(table 3) (11), as well as exercise and heat related causes.
Table 2 : Acquired causes of rhabdomyolysis. Poels & Gabreels
(1993) Clin Neurol Neurosurg 95 : 175-192.
Toxic
alcohol
drugs and toxins (see Table 3)
Excessive muscle exercise
sports and military training
status epilepticus
status asthmaticus
convulsions
prolonged myoclonus, acute dystonia
Direct muscle injury
crush
burning, freezing
electric shock, lightning stroke
Ischemic injury
compression
vascular occlusion
sickle cell trait
Metabolic disorders
diabetic ketoacidosis
nonketotic hyperosmolar coma
hypothyroidism
hypophosphatemia
hyponatremia
hypokalemia
Infections
bacterial
viral
Heat-related syndromes
toxic shock syndrome
heat stroke
Inflammatory myopathies
polymyositis
dermatomyositis
Others
anticholinergic syndrome
withdrawal of L-Dopa
Lots of possibilities.
Best regards.
DocVikingo
Ouch, but it hurts to even think of equine castration solely under such a drug.
In any event, here are some causes of rhabdomyolisis:
1 : Inherited causes of rhabdomyolysis. Poels & Gabreels
(1993) Clin Neurol Neurosurg 95 : 175-192.
Deficiencies of glyco(geno)lytic enzymes
myophosphorylase (McArdle's disease)
phosphorylase kinase
phosphofructokinase (Tarui's disease)
phosphoglycerate mutase
phosphoglycerate kinase
lactate dehydrogenase
Abnormal Lipid Metabolism
carnitine palmitoyltranferase deficiency I and II
carnitine deficiency
Other genetic disorders
idiopathic rhabdomyolysis
myoadenylate deaminase deficiency
malignant hyperthermia
neuroleptic malignant syndrome
Acquired causes may be divided into traumatic, ischaemic, metabolic, infectious, inflammatory, and toxic groups(table 3) (11), as well as exercise and heat related causes.
Table 2 : Acquired causes of rhabdomyolysis. Poels & Gabreels
(1993) Clin Neurol Neurosurg 95 : 175-192.
Toxic
alcohol
drugs and toxins (see Table 3)
Excessive muscle exercise
sports and military training
status epilepticus
status asthmaticus
convulsions
prolonged myoclonus, acute dystonia
Direct muscle injury
crush
burning, freezing
electric shock, lightning stroke
Ischemic injury
compression
vascular occlusion
sickle cell trait
Metabolic disorders
diabetic ketoacidosis
nonketotic hyperosmolar coma
hypothyroidism
hypophosphatemia
hyponatremia
hypokalemia
Infections
bacterial
viral
Heat-related syndromes
toxic shock syndrome
heat stroke
Inflammatory myopathies
polymyositis
dermatomyositis
Others
anticholinergic syndrome
withdrawal of L-Dopa
Lots of possibilities.
Best regards.
DocVikingo
The Iceni
Medical Moderator
I deliberately avoided going into great detail but the description now given suggests your man needs to take specialist advice because he has an underlying probem, one of the many listed by DocVikingo.
If he had fully recovered from a crush injury as the cause of the rhabdomyolysis, for example, I could see no problem. What is described is an ongoing problem and whatever the cause the individual will need not only to seek professional advice but to consider very carefully the peril he would be in should he have a severe attack when underwater.
Rhabdomyolysis itself is the breakdown of muscle tissue with the release of myoglobin and other large proteins that can block the kidney filter causing, in time, renal failure.
It would seem obvious that the blood supply to a cramped muscle would be greatly impaired thus reducing offgassing of the affected tissues but to my mind I suspect that the pain alone would prevent successful completion of an hour of decompression.
For this reason I do wonder if your man is fit to dive at all.:doctor:
If he had fully recovered from a crush injury as the cause of the rhabdomyolysis, for example, I could see no problem. What is described is an ongoing problem and whatever the cause the individual will need not only to seek professional advice but to consider very carefully the peril he would be in should he have a severe attack when underwater.
Rhabdomyolysis itself is the breakdown of muscle tissue with the release of myoglobin and other large proteins that can block the kidney filter causing, in time, renal failure.
It would seem obvious that the blood supply to a cramped muscle would be greatly impaired thus reducing offgassing of the affected tissues but to my mind I suspect that the pain alone would prevent successful completion of an hour of decompression.
For this reason I do wonder if your man is fit to dive at all.:doctor:
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