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Rhabdomyolysis in a Patient in an Emergency Unit

The paper contains a discussion on such a case study: ‘A 27-year-old patient with a history of substance abuse is found unresponsive by emergency medical services (EMS) after being called by the patient’s roommate. The roommate states that he does not know how long the patient has been lying there. The patient received naloxone in the field and has become responsive. He complains of burning pain in his left hip and forearm. Evaluation in the ED revealed a large amount of necrotic tissue over the greater trochanter as well as the forearm. EKG demonstrated prolonged PR interval and peaked T waves. Serum potassium level 6.9 mEq/L.’

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The patient’s complaints, the evaluation in the ED, and the conducted EKG method indicate the symptoms and signs of rhabdomyolysis. Such disease is evidenced by an increased level of potassium in the blood serum, as well as necrotic tissues (McCance & Huether, 2019). It is a clinical syndrome in which skeletal muscle tissue is destroyed. The subsequent release of intracellular ions, myoglobin, creatine kinase, and urates into the bloodstream leads to electrolyte disturbances, disseminated intravascular coagulation, renal failure, and multiple organ failure.

Most geneticists agree that there is a significant role in developing a genetic predisposition to dependence on harmful substances. The nature of this phenomenon is diverse, and in each particular case, it may be the result of the influence of various factors. However, the human genotype is the background on which they act and can strengthen or weaken the influence of other factors in the development of addictions. The predisposing environment includes factors contributing to the corresponding genetic characteristics (McCane & Huether, 2019). Besides, the causes of rhabdomyolysis may be metabolic myopathies – a group of hereditary diseases, the leading symptom of myoglobinuria. Rhabdomyolysis can result from inherited muscle disorders, infections and an internal deficiency of muscle enzymes, often manifest in childhood.

Although, another characteristic would change my response in as follow ways. As with other diseases, the vulnerability of one person more than another is determined by several factors. Risk factors increase the likelihood that taking harmful substances will lead to addiction. On the other hand, protective factors reduce the risk of developing a drug addiction (Saunders et al., 2016). The environment determines risk and protection factors – conditions at home, in public places, and biological characteristics – genes, age, gender, and ethnicity.

Rhabdomyolysis is the last stage of myopathy; muscle tissue is destroyed at the cellular level, the concentration of myoglobin and creatine kinase levels increases, and sudden renal failure develops. The leading cause of this disease is the breakdown of muscle cells (Cabral et al., 2020). Most likely, the patient is presenting with specific symptoms due to side effects of psychoactive substances, viral and bacterial diseases, and prolonged muscle tension. In addition, there is a high probability of exposure to hereditary genetic features.

Anaphylactic shock occurred; the patient lost consciousness and did not respond to calls in any way. Regarding such a phenomenon, doctors use naloxone in the case of a drug overdose, or hypersensitivity. Sensitivity and responsiveness are the patient’s physiological responses to the stimulus (Justiz-Vaillant & Zito, 2021). The reaction occurred due to the reversal of the overdose’s symptoms of harmful substances and the blocking of opioid receptors in the brain; the patient gradually regained consciousness and normalized breathing.

Muscle cells (myocytes) are mainly involved in this process because of the pathological process. Rhabdomyolysis can be the result of both traumatic damage and damage to the sarcolemma due to substance abuse – the membrane of myocyte cells. Defects in the metabolism of glucose, glycogen, lipids, and nucleosides, an ATP deficiency is detected in the tissues, resulting in muscle cells disintegrating, and free myoglobin appears in the systemic bloodstream. Under normal conditions, myoglobin does not enter the blood without damage or inflammation of muscle tissue. Myoglobin is highly toxic when it is free in the blood plasma (Cabral et al., 2020). Competing with the hemoglobin of red blood cells for binding to oxygen in the free myoglobin worsens the oxygen supply of tissues; it leads to the development of tissue hypoxia.

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Cabral, B. M. I., Edding, S. N., Portocarrero, J. P., & Lerma, E. V. (2020). Rhabdomyolysis. Disease-a-Month, 66(8), 101015. Web.

Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Web.

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed). St. Louis, MO: Mosby/Elsevier.

Saunders, J. B., Conigrave, K. M., Latt, N. C., Nutt, D. J., Marshall, E. J., Ling, W., & Higuchi, S. (Eds.). (2016). Addiction medicine (2nd ed.). Oxford University Press.

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