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1.
G Ital Nefrol ; 37(2)2020 Apr 09.
Artigo em Italiano | MEDLINE | ID: mdl-32281758

RESUMO

Rhabdomyolysis (R) is a complex condition involving the rapid dissolution of damaged or injured skeletal muscle. This leads to the direct release of intracellular components, including myoglobin, creatine kinase, aldolase, and lactate dehydrogenase, as well as electrolytes, into the bloodstream and extracellular space. Clinically, R shows a triad of symptoms: myalgia, limb weakness, and myoglobinuria without hematuria, while myoglobin has been recognized as playing a part in the development of acute kidney injury. Coturnism is a relatively rare disease, mostly found in the European countries bordering the Mediterranean Sea, characterized by acute R. It follows the consumption of Coturnix coturnix, a species of quails common in Europe, that have ingested the toxic substances (and especially coniine) present in the herbaceous plant called hemlock (Conium maculatum). Coniine may be lethal at a dose of 150 mg but it has neurotoxic effects at smaller doses, with acute R and acute kidney injury. Freezing and cooking the meat does not inactivate the alkaloids present in the birds' flesh and digestive tract. The clinical course of coturnism includes neurotoxicosis, tremor, vomiting, muscle paralysis, respiratory paralysis/failure, R and acute kidney injury. In appropriate geographical and temporal settings, it should be considered when diagnosing patients with acute R. The genetic, biochemical and epidemiological characteristics of coturnism are not yet fully known, while we wait reliable data from experimental studies.


Assuntos
Alcaloides/envenenamento , Doenças Transmitidas por Alimentos/complicações , Piperidinas/envenenamento , Codorniz , Rabdomiólise/etiologia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Animais , Doenças Transmitidas por Alimentos/diagnóstico , Humanos , Músculo Esquelético/lesões , Intoxicação por Plantas , Codorniz/metabolismo , Rabdomiólise/diagnóstico
2.
Biomed Environ Sci ; 32(10): 769-778, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31843046

RESUMO

Haff disease is a type of human rhabdomyolysis characterized by the sudden onset of unexplained muscular rigidity and an elevated serum creatine kinase level within 24 h after consuming cooked aquatic products. Here, we reviewed a previous study on Haff disease and summarized the clinical manifestations, epidemiological characteristics, and etiological data to confirm the incidence and global epidemiology of the disease and identify the most common seafood vectors. Future directions for Haff disease study will include further prospective etiological studies and the development of prevention and control strategies.


Assuntos
Rabdomiólise , Alimentos Marinhos/efeitos adversos , Humanos , Incidência , Rabdomiólise/diagnóstico , Rabdomiólise/epidemiologia , Rabdomiólise/etiologia
3.
J. bras. nefrol ; 41(4): 534-538, Out.-Dec. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1056606

RESUMO

ABSTRACT Introduction: The number of incident and prevalent patients on dialysis has increased, as well as the number of candidates for renal transplantation in Brazil, without a proportional increase in the number of organ donors. The use of expanded kidneys, as to renal function, may be an alternative to increase the supply of organs. Objective: to discuss the feasibility of using expanded kidneys for renal function, which are in severe acute renal injury. Methods: All cases of renal transplantation of deceased donors performed at the Hospital das Clínicas de Botucatu of UNESP, from January 2010 to June 2018, totaling 732 cases were evaluated. Cases with final donor creatinine greater than 6 mg/dL were selected. Results: four patients were selected, of whom all donors were in severe acute kidney injury (AKI). These donors presented rhabdomyolysis as a probable cause of severe AKI, were young, with no comorbidities and had decreased urinary volume in the last 24 hours. The clinical evolution of all the recipients was satisfactory, with a glomerular filtration rate after transplantation ranging from 48 to 98 mL/min/1.73 m2. Conclusion: this series of cases shows the possibility of using renal donors in severe AKI, provided the following are respected: donor age, rhabdomyolysis as the cause of AKI, and implantation-favorable biopsy findings. Additional studies with better designs, larger numbers of patients and longer follow-up times are needed.


RESUMO Introdução: O número de pacientes incidentes e prevalentes em diálise tem aumentado, assim como o número de candidatos ao transplante renal no Brasil, sem um aumento proporcional do número de doadores de órgãos. O uso de rins expandidos, quanto à função renal, pode ser uma alternativa para aumentar a oferta de órgãos. Objetivo: discutir a viabilidade do uso de rins expandidos quanto à função renal, que estejam em lesão renal aguda severa. Métodos: foram avaliados todos os casos de transplante renal de doador falecido realizados no Hospital das Clínicas de Botucatu da UNESP, de janeiro de 2010 a junho de 2018, totalizando 732 casos. Selecionou-se os casos com creatinina final do doador maior do que 6 mg/dL. Resultados: quatro pacientes foram selecionados, dos quais todos os doadores estavam em lesão renal aguda (LRA) severa. Esses doadores apresentavam rabdomiólise como provável causa de LRA severa, eram jovens, sem comorbidades e apresentavam diminuição de volume urinário nas últimas 24 horas. A evolução clínica de todos os receptores foi satisfatória, com taxa de filtração glomerular após o transplante variando entre 48 a 98 mL/min/1,73m2. Conclusão: essa série de casos mostra a possibilidade de utilização de doadores renais em LRA severa, desde que respeitadas as condições seguintes: idade do doador, rabdomiólise como causa de LRA e achados de biópsia favoráveis à implantação. Estudos adicionais com melhores desenhos, maior número de pacientes e maiores tempos de seguimento são necessários.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Rabdomiólise/diagnóstico , Doadores de Tecidos/estatística & dados numéricos , Transplante de Rim/métodos , Função Retardada do Enxerto/diagnóstico , Lesão Renal Aguda/cirurgia , Projetos de Pesquisa , Brasil/epidemiologia , Cadáver , Estudos de Viabilidade , Estudos Retrospectivos , Diálise Renal/estatística & dados numéricos , Transplante de Rim/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Creatinina/sangue , Função Retardada do Enxerto/etiologia , Lesão Renal Aguda/etiologia , Taxa de Filtração Glomerular/fisiologia , Sobrevivência de Enxerto/fisiologia , Rim/fisiopatologia
4.
BMJ Case Rep ; 12(10)2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586959

RESUMO

Neuropsychiatric and muscular symptoms can develop as part of hypothyroidism. However, frank psychosis or rhabdomyolysis due to hypothyroidism are uncommon and have been reported rarely as the first presenting features of hypothyroidism. We report a case of a 44-year-old man who presented with a 2-week history of delusions, hallucinations and mild bilateral leg pain, without apparent signs of myxedema. Investigations revealed raised thyroid stimulation hormone >100 mIU/L and high creatine kinase >21 000 U/L. Diagnosis of hypothyroidism-induced psychosis and rhabdomyolysis was made. He received thyroxine, olanzapine and a short course of steroids. His symptoms improved after 2 weeks of treatment and he remained free of symptoms at 6 months of follow-up. To the best of our knowledge, this is the first case of concomitant psychosis and rhabdomyolysis leading to hypothyroidism diagnosis. This case highlights the importance of hypothyroidism screening when faced with unexplained psychosis or rhabdomyolysis, especially if combined.


Assuntos
Hipotireoidismo/diagnóstico , Transtornos Psicóticos/etiologia , Rabdomiólise/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Masculino , Rabdomiólise/sangue , Rabdomiólise/complicações , Rabdomiólise/tratamento farmacológico , Tiroxina/administração & dosagem , Tiroxina/uso terapêutico
5.
Korean J Gastroenterol ; 74(2): 115-118, 2019 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-31438663

RESUMO

Ischemic colitis primarily affects the elderly with underlying disease, but it rarely occurs in young adults with risk factors, such as coagulopathy or vascular disorder. Moreover, it is extremely rare in the very young without risk factors. This paper presents a patient with ischemic colitis associated with heat stroke and rhabdomyolysis after intense exercise under high-temperature conditions. A 20-year-old man presented with mental deterioration after a vigorous soccer game for more than 30 minutes in sweltering weather. He also presented with hematochezia with abdominal pain. The laboratory tests revealed the following: AST 515 U/L, ALT 269 U/L, creatine kinase 23,181 U/L, BUN 29.1 mg/dL, creatinine 1.55 mg/dL, and red blood cell >50/high-power field in urine analysis. Sigmoidoscopy showed ischemic changes at the rectum and rectosigmoid junction. A diagnosis of ischemic colitis and rhabdomyolysis was made, and the patient recovered after conservative and fluid therapy. This case showed that a diagnosis of ischemic colitis should be considered in patients who present with abdominal pain and bloody diarrhea after intense exercise, and appropriate treatment should be initiated immediately.


Assuntos
Colite Isquêmica/diagnóstico , Rabdomiólise/diagnóstico , Colite Isquêmica/etiologia , Colite Isquêmica/terapia , Exercício Físico , Hidratação , Golpe de Calor , Humanos , Masculino , Rabdomiólise/complicações , Sigmoidoscopia , Tomografia Computadorizada por Raios X , Adulto Jovem
6.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451475

RESUMO

A 62-year-old previously healthy male was admitted with new onset generalised tonic-clonic seizures. Treatment was initiated with the antiepileptic levetiracetam and he had no further episodes of seizures. Creatine kinase (CPK) level was 1812 IU/L 12-hour postadmission. Despite good hydration, his CPK levels continued to rise dramatically and reached a level of 19 000 IU/L on day 5. This rise was unexplained as he did not have any further seizures and had a normal renal function. In the absence of other risk factors, the rare possibility of levetiracetam being responsible for the disproportionately high CPK was considered. Within 12 hours of withdrawal of levetiracetam, there was a downward trend in the CPK levels, with a 10-fold decrease in CPK levels over the next 4 days. This is only the ninth case reported in literature regarding this rare and potentially serious adverse effect of levetiracetam.


Assuntos
Creatina Quinase/sangue , Substituição de Medicamentos/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Levetiracetam , Rabdomiólise , Convulsões/tratamento farmacológico , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/sangue , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Humanos , Levetiracetam/administração & dosagem , Levetiracetam/efeitos adversos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Fenitoína/administração & dosagem , Rabdomiólise/sangue , Rabdomiólise/induzido quimicamente , Rabdomiólise/diagnóstico , Rabdomiólise/terapia , Convulsões/diagnóstico , Resultado do Tratamento
7.
Biomed Res Int ; 2019: 1345923, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467868

RESUMO

Snakebite envenoming is a neglected public health issue in many tropical and subtropical countries. To diagnosis and treat snakebites may be challenging to health care personnel since sufficient information has not been yet provided. This review presents the clinical, therapeutic, and laboratory aspects of Crotalus durissus (South American rattlesnakes) victims. The clinical setting may show local effects such as little or no pain, mild edema, and recurrent erythema. In contrast, the systemic effects may be quite remarkable, such as changes due to neurological damage, intense rhabdomyolysis, incoagulability of the blood, and variations in the peripheral blood elements. The main complication is acute kidney injury. The appropriate treatment depends mainly on the correct recognition of the aggressor snake and the symptoms expressed by the victim. Rattlesnake venom can cause irreparable damage and lead to death. Therefore, a prompt diagnosis allows the immediate onset of proper serotherapy.


Assuntos
Lesão Renal Aguda/diagnóstico , Antivenenos/uso terapêutico , Crotalus , Mordeduras de Serpentes/diagnóstico , Lesão Renal Aguda/tratamento farmacológico , Lesão Renal Aguda/patologia , Lesão Renal Aguda/prevenção & controle , Animais , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/patologia , Venenos de Crotalídeos/efeitos adversos , Humanos , Imunização Passiva , Rabdomiólise/diagnóstico , Rabdomiólise/tratamento farmacológico , Rabdomiólise/patologia , Mordeduras de Serpentes/tratamento farmacológico , Mordeduras de Serpentes/patologia , Mordeduras de Serpentes/prevenção & controle
10.
Medicine (Baltimore) ; 98(28): e16244, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305403

RESUMO

RATIONALE: The incidence exercise-induced rhabdomyolysis is increasing in the healthy general population. Rhabdomyolysis can lead to the life-threatening systemic complications of acute kidney injury (AKI), compartment syndrome, and disseminated intravascular coagulopathy. PATIENT CONCERNS: A 21-year-old man had bilateral lower limb pain and soreness, dark brown urine after lower exremity training. Laboratory results showed that creatinine kinase (CK) and myoglobin (Mb) increased to 140,500 IU/L and 8632 µg/L respectively, with elevated liver enzymes, Scr, and proteinuria. DIAGNOSES: Exercise-induced rhabdomyolysis with AKI. INTERVENTIONS: The patient was hospitalized and treated with vigorous hydration and sodium bicarbonate for 6 days. OUTCOMES: After 6 days of treatment, the patient had a significant decrease in the CK and Mb levels. His renal function returned to normal. His laboratory tests had completely normalized during 2-week follow-up. LESSONS: Exercise-induced rhabdomyolysis can cause serious complications such as AKI. Delayed diagnosis can be critical, so timely manner should be taken to achieve a favorable prognosis.


Assuntos
Lesão Renal Aguda/etiologia , Lesão Renal Aguda/fisiopatologia , Exercício Físico , Extremidade Inferior , Rabdomiólise/etiologia , Rabdomiólise/fisiopatologia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/tratamento farmacológico , Diagnóstico Diferencial , Exercício Físico/fisiologia , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Rabdomiólise/diagnóstico , Rabdomiólise/tratamento farmacológico , Adulto Jovem
13.
Intern Med ; 58(19): 2887-2890, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31243202

RESUMO

Rhabdomyolysis is a relatively common and life-threatening disease that is sometimes complicated by acute kidney injury (AKI). Several causes have been reported, divided into traumatic and non-traumatic causes. We herein report a patient with rhabdomyolysis with AKI caused by bilateral iliopsoas hematoma. This patient had atrial fibrillation that was poorly controlled with warfarin, and bilateral iliopsoas hematoma was caused by turnover without a history of high-energy injury. Treatment with the rapid neutralization of warfarin improved his clinical condition without complications. We should pay close attention to episodes of turnover among elderly patients receiving anticoagulant therapy.


Assuntos
Lesão Renal Aguda/etiologia , Fibrilação Atrial/tratamento farmacológico , Hematoma/complicações , Músculo Esquelético/irrigação sanguínea , Rabdomiólise/etiologia , Lesão Renal Aguda/diagnóstico , Idoso , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Hematoma/induzido quimicamente , Hematoma/diagnóstico , Humanos , Masculino , Músculo Esquelético/diagnóstico por imagem , Espaço Retroperitoneal , Rabdomiólise/diagnóstico , Tomografia Computadorizada por Raios X , Varfarina/efeitos adversos , Varfarina/uso terapêutico
14.
BMJ Case Rep ; 12(5)2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31126931

RESUMO

A 43-year-old man presented with acute onset rapidly progressive weakness in all four limbs (proximal greater than distal), following an episode of binge alcohol ingestion, and was admitted for evaluation and management. There was a history of decreased urine output since 2 days with dark-coloured urine. He was found to have severe hypokalemia and renal dysfunction. Serum creatine kinase was significantly high, and further investigation revealed significantly elevated serum and urine myoglobin levels suggestive of rhabdomyolysis, which was secondary to severe hypokalemia. Following supplementation with intravenous and oral potassium and supportive care, the weakness improved significantly, and he was subsequently discharged. This case describes severe hypokalemia, resulting in rhabdomyolysis and generalised lower motor neuron weakness, in a setting of binge alcohol ingestion, which is an entity rarely described in literature.


Assuntos
Bebedeira , Hipopotassemia/diagnóstico , Potássio/uso terapêutico , Rabdomiólise/diagnóstico , Administração Oral , Adulto , Diagnóstico Diferencial , Humanos , Hipopotassemia/sangue , Hipopotassemia/complicações , Hipopotassemia/tratamento farmacológico , Infusões Intravenosas , Masculino , Potássio/administração & dosagem , Rabdomiólise/complicações
15.
Anaesth Intensive Care ; 47(2): 128-133, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31070454

RESUMO

Some degree of exertional rhabdomyolysis (ER), striated muscle breakdown associated with strenuous exercise, is a well-known phenomenon associated with endurance sports. However in rare cases, severe and/or recurrent ER is a manifestation of an underlying condition, which puts patients at risk for significant morbidity and mortality. Selecting the patients that need a diagnostic work up of an acute rhabdomyolysis episode is an important task. Based on the diagnostic work up of three illustrative patients treated in our hospital, retrospectively using the 'RHABDO' screening tool, we discuss the clinical and biochemical clues that should trigger further investigation for an underlying condition. Finally, we describe the most common genetic causes of this clinical syndrome.


Assuntos
Exercício Físico , Rabdomiólise , Humanos , Músculo Esquelético/patologia , Estudos Retrospectivos , Rabdomiólise/diagnóstico , Rabdomiólise/etiologia
18.
Artigo em Chinês | MEDLINE | ID: mdl-30929357

RESUMO

Objective: To analyze the clinical characteristics, treatment and prognosis of rhabdomyolysis (RM) caused by acute poisoning.Summarize the clinical characteristics and treatment experience, pay attention to the complications and improve the quality of rescue. Methods: We collecte and summarize the clinical data, treatment and prognosis of 22 cases of RM caused by acute poisoning. Results: We found that 21 patients (95.5%) had muscle damage, 13(59.1%) with coma, 8(36.4%) with brown, tea or even soy sauce urine, 6(27.3%) had acute renal injury (AKI), and 4(18.2%) had multiple organ dysfunction syndrome (MODS). After the treatment, 21 cases (95.5%) got better, and one case were discharged. All the patients with AKI were survived, three of them were treated by hemodialysis, and the other recovered gradually after massive fluid replacement. Conclusion: Acute poisoning combined with RM is not uncommon in clinic. We should pay attention to examination of serum enzymes and other indicators, observe the clinical symptoms and make early diagnosis. The key to diagnosis and treatment is early fluid resuscitation, comprehensive treatment, blood purification and maintain the stability of water and electrolyte.


Assuntos
Envenenamento/complicações , Rabdomiólise/diagnóstico , Rabdomiólise/terapia , Lesão Renal Aguda , Humanos , Insuficiência de Múltiplos Órgãos , Prognóstico , Diálise Renal
19.
Medicine (Baltimore) ; 98(17): e15149, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027057

RESUMO

RATIONALE: With the existence of the human immunodeficiency virus (HIV) infection as a chronic disease, more often adverse effects of its treatment with the various antiretroviral therapies (ARTs) available have been recognized. Going further, Triumeq has been associated with a myriad of adverse effects, of which rhabdomyolysis is rarely reported in the literature. PATIENT CONCERNS: The patient presented with muscle tenderness over the lower limbs and dark brown-to-red colored urine. DIAGNOSIS: Given the presenting symptoms, as well as the laboratory testing, including elevated serum creatine kinase and liver enzymes, the diagnosis of rhabdomyolysis was made. INTERVENTIONS: Improvement was achieved rapidly after starting intravenous fluid therapy and with discontinuation of Triumeq. OUTCOMES: After discharge, repeated creatine kinase levels in the clinic have been normal and decision was made to initiate another ART and until now, no further episodes of rhabdomyolysis have developed. Regular outpatient follow-up has been ongoing for over 1 year and no complications have been identified. LESSONS: This case aims to recognize rhabdomyolysis as a rare, but possible adverse effect associated with the use of Triumeq for HIV-infected patients and therefore clinicians prescribing this combination should be aware of this potential side effect and counsel their patients accordingly.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Didesoxinucleosídeos/efeitos adversos , Infecções por HIV/tratamento farmacológico , Compostos Heterocíclicos com 3 Anéis/efeitos adversos , Lamivudina/efeitos adversos , Rabdomiólise/etiologia , Fármacos Anti-HIV/uso terapêutico , Didesoxinucleosídeos/uso terapêutico , Combinação de Medicamentos , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Humanos , Lamivudina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Rabdomiólise/diagnóstico , Rabdomiólise/terapia
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