Introduction
Rhabdomyolysis is a condition that occurs when damaged muscle tissue releases its chemical contents into the bloodstream, resulting in damage to organs and other tissues around the body. It was first recorded in 1908 after an earthquake (Stahl et al., 2020). The condition typically happens when exposed to intense heat, over-exercising, and blunt force trauma (Stahl et al., 2020).
It is one of the diseases frequently found in individuals doing hard manual labor. Many incidents occur in the aftermath of natural disasters, such as fires, floods, and tornadoes, which expose people to injuries. There are approximately 26,000 cases reported every year in the US alone, though many more remain undetected (Stahl et al., 2020). The disease is dangerous and can cause severe health complications as well as result in death. This paper aims to describe the pathology and normal anatomy and physiology of the major body systems affected, cover the mechanism of pathophysiology, and prevent and treat rhabdomyolysis.
Normal Anatomy of the Major Body Systems Affected
The significant systems affected by rhabdomyolysis are the heart and the kidneys. Kidneys are the organs that filter out extra water from the blood. The glomerular filtration rate measures this parameter. Healthy kidneys typically have their filtration rate at 60 or above, indicating healthy functioning (Cabral et al., 2020). In addition, kidneys prevent albumin, a protein, from going into the urine (Cabral et al., 2020). Healthy kidneys block all and any albumin from going through, whereas the presence of such indicates damage.
The heart is a vital organ that pumps blood through the entirety of the human body. The typical measurements to describe the normal anatomy of a heart include blood pressure, heartbeat rate, and blood tests, among others (Cabral et al., 2020). Blood pressure in a healthy heart is around 120/80, possibly increasing to 140/90 for some people (Cabral et al., 2020). Further increases or decreases may indicate irregularities in heart function.
A healthy person’s average resting heart rate is between 60 and 90 heartbeats (Cabral et al., 2020). There may be health reasons for such occurrences if it is above or below. Finally, blood tests show between 4-6 million cells per mcL, 4.500-10.000 white cells, 140.000-450.000 platelets, and normal hemoglobin and hematocrit parameters for both men and women (Cabral et al., 2020). Rhabdomyolysis causes differentiation in these parameters, which may indicate its presence.
Normal Physiology of the Major Body Systems Affected
The conduction system of the heart is comprised of several elements. The first one is the sinoatrial node, the heart’s pacemaker. It requires no neural stimulation to initiate contracting impulses at 70-90 times a minute (Kodadek et al., 2022). All other elements in the heart exist to regulate its contraction and relaxation parameters. These include the conduction myofibers, atrioventricular node and bundle, and bundle branches.
Kidneys, however, are a critical part of the renal system. Its purpose is to filter the blood flow and remove toxins, metabolic wastes, and excess water while maintaining a healthy balance of essential elements (Kodadek et al., 2022). The process of plasma osmolarity is regulated by balancing water, electrolytes, and various other soluble elements within the stream (Kodadek et al., 2022). Kidneys also produce erythropoietin to ensure the production of red blood cells (Kodadek et al., 2022). Another element produced in the kidneys, called renin, regulates blood pressure and activates vitamin D.
Mechanism of Pathophysiology
Rhabdomyolysis can occur due to a mechanical injury due to exposure to poisons, toxins, chemical reagents, and burns. These injuries can result in cellular damage to the membranes throughout the body (Cabral et al., 2020). When cells are damaged and ruptured, they release intracellular elements into the bloodstream. These include potassium, myoglobin, phosphates, purines, and lactic acids, which are then transported by blood to the rest of the body.
These components can become toxic in time and cause long-term damage or even death, thus making the treatment of the disease a medical urgency. If the muscle is not continuously injured, the myoglobin levels return to normal within 6-8 hours due to the body repairing itself (Kodadek et al., 2022). Prolonged injury may result in excess myoglobin that the glomerulicprocess cannot filter out.
The excess can overload the proximal tubules and their ability to convert iron. As a result, intracellular iron accumulation may occur. Iron is a source of free electrons and can generate free radicals. These radicals can increase urine pH and cause metabolic acidosis, which further stresses and injures the renal cells (Kodadek et al., 2022). As a result, the entire renal system can collapse due to cell failure.
When the tubules cannot deal with excess myoglobin, the body starts the process known as systemic vasoconstriction. The tubules reabsorb water, increasing the concentration of the initial problem element within urine (Cabral et al., 2020). Renal tubules are obstructed by blockages through apoptosis in epithelial cells (Kodadek et al., 2022). This connects to forming free radicals from iron, increasing the chances of renal failure.
The final element contributing to the pathophysiology of rhabdomyolysis is potassium. It is produced during the muscle lysis and can enter the bloodstream due to damage. Excess of potassium is dangerous to the heart, as it can cause cardiotoxicity (Kodadek et al., 2022). The typical symptom of excess potassium is arrhythmia, which occurs due to potassium-induced ventricular fibrillation (Kodadek et al., 2022). Finally, calcium released from damaged muscle tissues as part of rhabdomyolysis can lead to hyperkalemia hypercalcemia, and also result in heart failure.
Prevention
The causes of rhabdomyolysis are not fully understood, so the potential for prevention is somewhat limited. Nevertheless, there are a few ways in which it is possible to reduce the risk of developing such a problem. First and foremost, it is recommended to modulate one’s physical activity. It is best to get used to the type of workload one is expected to do before performing it for extended periods.
Taking brief breaks and keeping oneself hydrated will also help prevent rhabdomyolysis (Kodadek et al., 2022). Finally, one should protect oneself from blunt injuries by utilizing proper equipment and watching one’s physical state before committing to work (Kodadek et al., 2022). Individuals within risk groups should also avoid hard labor when feeling ill.
Treatment
Treatment of rhabdomyolysis depends on the severity of the case. Most cases that are not reported can be improved upon by drinking fluids, resting, and cooling off. Moderate and severe cases, however, may require hospital admission (Cabral et al., 2020). Intravenous fluids must be administered into the blood flow to help remove the electrolytes and dangerous proteins (Cabral et al., 2020). In addition, the hospital staff will be able to monitor the patient for heart and kidney abnormalities, seizures, and high potassium levels and treat those accordingly.
Conclusion
Rhabdomyolysis is a disease that occurs when people receive blunt force trauma, overwork themselves, suffer from heat exhaustion, intoxication, and a multitude of other reasons. The condition has the potential to become dangerous and even deadly. To prevent it, individuals should avoid working in the heat for an extended period, as well as injuries and exposure. Rest, rehydration, and IV fluids may be used to treat the patient in light of severe cases.
References
Cabral, B., Edding, S. N., Portocarrero, J. D. R., & Lerma, E. V. (2020). Rhabdomyolysis. Dm Disease-a-month, 66(8). Web.
Kodadek, L. M., Carmichael, S. P., Seshadri, A. J., Pathak, A., Hoth, J., Appelbaum, R., Michetti, C. P., & Gonzalez, R. (2022). Rhabdomyolysis: An American association for the surgery of trauma critical care committee clinical consensus document. Trauma Surgery & Acute Care Open, 7(1). Web.
Stahl, K., Rastelli, E., & Schoser, B. (2020). A systematic review on the definition of rhabdomyolysis. Journal of Neurology, 267(4), 877–882. Web.