A Case Of Rhabdomyolysis And Acute Kidney Injury With Literature Review

【Background】Rhabdomyolysis(RM)is a metablic disorder and organ dysfunction syndrome,resulting from rhabdomyocyte injury and necrosis which mediated by various causes,leading to the release of muscle cell constituents such as myoglobin and creatine kinase(creatine kinase,CK)released into the blood ciuculation.The clinical manifestations of typical RM are muscular pain,weakness and dark urine.In more severe cases,patients will experience acute renal injury(AKI),disseminated intravascular coagulation,malignant arrhythmia,serious electrolyte acid-base balance disorder and multiple organ failure.Among them,AKI and arrhythmia are the most common complications.Once they occur,the mortality rate will increase significantly.【Case report】An 83-year-old male patient,was admitted to the general ward of geriatric department for shortness of breath on exertion over 3 years and worsening condition for 2 weeks,and another 2 days on July,06,2017.The relevant examination has been completed after admission.The diagnostic results were as follows,1.coronary atherosclerotic heart disease(1)heart function 3 2.hypertension 3(high risk group)3.cholecystolithiasis and chronic cholecystitis 4.gastroduodenal polyp 5.intestinal polyps after electrotomy of 6.pancreatic space occupying lesions(pancreatic cystic adenoma)7.prostatic hyperplasia.After admission,he received anti-heart failure and antihypertensive treatments based on his symptoms.Because of additional symptoms such as restless at night,day-night reversal and unable to sleep during hospitalization,5mg olanzapine was prescribed to him every night.However,after taking them for 12 days,his urine volume decreased,and color deepened,accompanied by generalized weakness,rapid breathing,progressive deterioration of heart,liver and kidney function.The auxiliary examination showed a significant increase in creatine kinase and myoglobin.Based on the examination he was diagnosed with rhabdomyolysis and,was transferred to ICU on August,02,2017 in the geriatric department for further treatment.He received blood purificaiton treatment(continuous veno-venous hemofiltration(CVVH)model,5 times,a total of 32 hours)+ hemoperfusion(Hemoperfusion,HP)(1 times,2 hours).Continuous veno-venous filtration: Seldinger technique was used establish vascular access by setting up a single needle and double cavity femoral vein catheterization.Baxter ACCURRA bedside blood purifier,Fresenius AV600 blood filter,blood flow 200ml/ min,2L/h pre dilution method input,low molecular weight heparin(first dose 0.2ml,0.2ml or non appending)anticoagulation.Hemoperfusion: using baiter ACCURRA bedside blood purification machine,HA330 blood perfusion device of Zhuhai Li Zhu medical device Co.,Ltd.,low molecular weight heparin anticoagulant,1 sex use,time 2h,blood flow 200ml/min.Surveillance indicators: blood routine test,biochemical eight items test and coagulation four items test were examined before,during,and after treatment.After the above treatment,his asthenia symptoms improved,urine volume increased,and creatine kinase decreased significantly.6 days after transferring to ICU,he had four sudden cardiac arrest and was given,positive cardiopulmonary resuscitation,installation of pacemaker and other symptomatic support treatment.The patient’s condition improved and returned to the general ward of the geriatric department to continue the treatment.【Conclusion】1.The etiology of rhabdomyolysis is relatively complex.Generally,it is classified into two categories: traumatic and non-traumatic.2.The clinical manifestations of typical rhabdomyolysis are musclar pain,weakness,and urine color changes.Oliguria and elevated serum creatinine may occur in patients with acute renal injury.3.The detailed pathogenesis of rhabdomyolysis induced acute kidney injury is not fully elucidated,although experimental evidence suggests that oxidative stress,inflammation,and renal tubular cell apoptosis are the main mechnisms involved.4.Early diagnosis,early removal of the cause,active liquid treatment and blood purification are the key to reducing mortality and improving the prognosis of patients.In this case,the CVVH+HP blood purification technique has been used and the patient recovered very well.Once the symptomatic bradycardia and other complications present,it is reliable to use cardiac pacemaker in time and can also save time for the treatment of primary diseases.