MyMedR

Fulltext Rhabdomyolysis in a recreational swimmer

Stella JJ, Shariff AH

Singapore Med J, 2012 Feb;53(2):e42-4.

Rhabdomyolysis is a clinical and biochemical syndrome resulting from skeletal muscle injury, which may ultimately lead to acute renal failure (ARF) and death. Exertional rhabdomyolysis refers to skeletal muscle injury that is usually induced by strenuous eccentric exercises in a hot and humid environment. It is usually seen in marathoners and military personnel. We present the case of a 32-year-old Malaysian man who had rhabdomyolysis and myoglobinuria without ARF after two episodes of unaccustomed swimming. He was treated conservatively, and recovered uneventfully. A brief discussion on the pathophysiology of rhabdomyolysis, the principles of management and recuperation is included.

Matched MeSH terms: Rhabdomyolysis/diagnosis; Rhabdomyolysis/etiology*; Rhabdomyolysis/physiopathology; Rhabdomyolysis/therapy

Fulltext Rhabdomyolysis due to Lamivudine administration in acute viral hepatitis B infection: a case report from Malaysia

Baharin J, Sahari NS, Lim SM

Electron Physician, 2014;6(3):863-7.

PMID: 25763159 DOI: 10.14661/2014.863-867

Rhabdomyolysis is a serious but rare side effect of Lamivudine treatment. Therefore, appropriate biochemical monitoring should be undertaken when it is used in the treatment of hepatitis B. This paper presents a case of Lamivudine-associated rhabdomyolysis in a 31-year-old man with congenital heart disease and hepatitis B. Three days after starting Lamivudine, the patient developed myalgia. Significant muscle tenderness and swelling of the upper and lower limbs was discovered during a physical examination. Creatine kinase was markedly raised. Lamivudine-induced rhabdomyolysis was suspected and the drug was discontinued. Symptoms and creatine kinase activity improved within four days of Lamivudine cessation and hydration. Early identification of Lamivudine-induced rhabdomyolysis is key in preventing this potentially fatal drug reaction; withdrawal of Lamivudine may contribute to complete remission of rhabdomyolysis.

Matched MeSH terms: Rhabdomyolysis*

Fulltext Exercise-induced rhabdomyolysis with acute renal failure after strenuous push-ups

Keah SH, Chng KS

Malays Fam Physician, 2009;4(1):37-9.

PMID: 25606158

We report a case of a young Chinese female who developed acute rhabdomyolysis with acute renal failure after a strenuous push-up exercise during a company motivation course. She managed to make full recovery after a period of outpatient treatment.

Matched MeSH terms: Rhabdomyolysis

Rhabdomyolysis and acute renal failure following blowpipe dart poisoning

Ho LM, Cheong I, Jalil HA

Nephron, 1996;72(4):676-8.

PMID: 8730441

The latex of pokok ipoh (Antiaris toxocaria) and the root bark of akar ipoh (Strychnos species) have been the main sources of the poisonous principles in dart and arrow poisons prepared throughout south-east Asia. We report a fatal case of rhabdomyolysis and acute oliguric renal failure following oral ingestion of blowpipe dart poison. To our knowledge this is the first such report.

Matched MeSH terms: Rhabdomyolysis/chemically induced*; Rhabdomyolysis/pathology

Cefepime-associated thrombocytopenia in a critically ill patient

Lim PP, Chong CP, Aziz NA

Int J Clin Pharm, 2011 Dec;33(6):902-4.

PMID: 21986835 DOI: 10.1007/s11096-011-9571-5

CASE: Cefepime-induced thrombocytopenia is a rare adverse event (incidence <1.0%), based on data from clinical trials. However, there is limited post-marketing surveillance documentation on thrombocytopenia associated with cefepime. We describe a 45-year-old male who was admitted to the intensive care unit after allegedly being hit by a large metal bar in the right upper chest and shoulder. Rhabdomyolysis secondary to the trauma, pneumothorax, acute renal failure, and nosocomial sepsis were subsequently diagnosed. Four days after intravenous cefepime initiation, the patient developed thrombocytopenia with platelet count dropping from 102 × 10(3)/μL to 15 × 10(3)/μL. Cefepime was discontinued and the platelet count normalized to 140 × 10(3)/μL after 6 days. Use of the Naranjo adverse drug reaction probability scale indicated a possible relationship between the patient's thrombocytopenia and cefepime therapy.

CONCLUSION: Although cefepime-induced thrombocytopenia is rare, clinicians should be alert to this potential adverse effect among critically ill patients.

Matched MeSH terms: Rhabdomyolysis/complications; Rhabdomyolysis/etiology

Fulltext Rhabdomyolysis associated with hypokalaemic periodic paralysis of renal tubular acidosis

Hanip MR, Cheong IK, Chin GL, Khalid BA

Singapore Med J, 1990 Apr;31(2):159-61.

PMID: 2371581

Two cases of hypokalaemia with serum potassium levels of 1.4 mmol/L and 1.9 mmol/L causing severe periodic paralysis since childhood are presented. There were associated with muscular aches and markedly raised muscle enzymes suggesting massive rhabdomyolysis. These abnormalities were due to renal tubular acidosis with markedly acidic arterial pH. The hypokalaemia and rhabdomyolysis responded to potassium and bicarbonate replacement. We postulate these patients had sporadic distal type of renal tubular acidosis and that the hypokalaemia and acidosis had caused the rhabdomyolysis.

Matched MeSH terms: Rhabdomyolysis/etiology*; Rhabdomyolysis/physiopathology

Familial Paroxysmal Rhabdomyolysis, non-exertional type, in a Malay family - a case report

Hussain Imam Muhammad Ismail, Azizi Omar

Malaysian Journal of Child Health, 1993;5(1):57-61.

MyJurnal

Familial Paroxysmal Rhabdomyolysis of the non-exertional variety is a rare but treatable disorder previously not described in Malaysia. We report 3 Malay siblings of a consanguinous marriage who developed myoglobulinuria during a febrile illness. The first 2 died without being investigated, but the last had creatinine kinase levels of 24,800 UIL suggesting acute rhabdomyolysis. Fasting appears to be a major precipitating factor, and glucose infusions combined with alkaline diuresis may be life-saving.

Matched MeSH terms: Rhabdomyolysis

Fulltext Doing less is better: challenges in complex polytrauma management - case report

Farah, N.A., Johar, M.J., Ismail, M.S.

Medicine & Health, 2018;13(1):251-258.

MyJurnal

Damage control resuscitation, characterized by hemostatic resuscitation with blood products, rapid arrest of bleeding and when possible, permissive hypotension with restricted fluid load form a structured approach in managing a polytrauma patient. When complicated with traumatic rhabdomyolysis however, permissive hypotension strategy may cause more harm resulting in subsequent ischaemicreperfusion injury and acute kidney injury. We present a case involving a 20-yearold man who was rolled over by a lorry and sustained an open unstable pelvic fracture with vascular injury and left lower limb ischaemia. Permissive hypotension strategy was pursued for 4 hours prior to bleeding control in OT. This was followed by protracted surgery of 6 hours. Coagulopathy, acute kidney injury and rhabdomyolysis ensued in the post-operative period and patient succumbed to his injury on Day 3 post-trauma. Challenges and pitfalls in managing a complex polytrauma patient and recent evidences on damage control resuscitation is discussed.

Matched MeSH terms: Rhabdomyolysis

Fulltext Risk of acute kidney injury and hyponatremia in long-distance runners

Abdullah R., Wan Md Adnan W.A.H.

JUMMEC, 2018;21(2):4-9.

MyJurnal

Long-distance running has gathered some momentum among health-conscious participants. However, some
studies have revealed association between long-distance running and development of acute kidney injury.
Although the impact usually lasts only for a few days after the event, some participants have been admitted for
severe acute kidney injury, the minority of which require dialysis treatment. The mechanisms underlying the
injury may include dehydration, development of rhabdomyolysis, heat stroke and concomitant use of NSAIDS.
Unfortunately, there is no long-term follow-up study to determine the long-term effect on kidney function.
Acute hyponatremia may develop in a significant proportion of long-distance runners. Majority of them were
asymptomatic but a few fatal cases which were supposedly due to cerebral oedema have been reported.
Excessive intake of hypotonic drinks, excessive sweating and secretion of non-osmotic antidiuretic hormone
have been postulated to be the causes of hyponatremia. This mini review will discuss the pathophysiology of
the development of acute kidney injury and hyponatremia. It will also discuss the prevention and treatment
of both conditions.

Matched MeSH terms: Rhabdomyolysis

Fulltext Rhabdomyolysis and acute renal failure following a switchover of therapy between two fibric acid derivatives

Kamaliah MD, Sanjay LD

Singapore Med J, 2001 Aug;42(8):368-72.

PMID: 11764054

Drug induced myopathy has been reported with the use of fibric acid derivatives, hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors and nicotinic acid. Over the last three decades, hypolipemiants like fibric acid derivatives and statins have been increasingly recognised as causes of rhabdomyolysis and acute renal failure especially during combination therapy and in the presence of underlying renal impairment. We report two cases of bezafibrate-induced rhabdomyolysis in patients with underlying coronary artery disease and pre-existing renal impairment. Both patients developed rhabdomyolysis leading to acute renal failure soon after their hyperlipidaemia treatment was changed from gemfibrozil to bezafibrate. There were no intercurrent illnesses or co-administration of other lipid lowering drugs in both patients. Even though both drugs belong to the same fibric acid derivatives group, these patients developed the complication only after a switchover of therapy.

Matched MeSH terms: Rhabdomyolysis/chemically induced*

Idiopathic ileal volvulus with multiple concomitant infections in a starving man

Tan LJ, Othman MS, Hiu J, Wong KT, Lai SK

Malays J Pathol, 2021 Apr;43(1):81-85.

PMID: 33903310

BACKGROUND: Small bowel volvulus is defined as the torsion of the small intestine, potentially leading to bowel obstruction, gangrene and perforation. It is a rare condition, especially in adults.

CASE PRESENTATION: A 30-year-old man was retrieved from the jungle with severe weight loss and abdominal symptoms. He succumbed to death despite 22 days of intensive medical treatment. An autopsy revealed a ruptured gangrenous ileal volvulus with peritonitis and subdiaphragmatic abscess. Further laboratory analysis detected systemic Candida tropicalis and intestinal gramnegative bacterial sepsis, systemic Zika virus viremia, leptospirosis complicating rhabdomyolysis and disseminated intravascular coagulopathy, Type I Herpes Simplex virus infection of the tongue and upper gastrointestinal tract. The cause of death was the ruptured ileal volvulus, complicated with upper gastrointestinal bleeding due to Herpes simplex virus esophagitis in a malnourished patient with resolving leptospirosis and underlying Zika virus co-infection.

CONCLUSION: Rare clinical scenarios of adult-onset intestinal volvulus with concomitant multiple infections precludes clinical diagnosis and early treatment, leading to devastating consequences of clinical outcome. The positive clinical and postmortem correlation is a good learning lesson in many disciplines of medicine and science.

Matched MeSH terms: Rhabdomyolysis

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