Rabdomiolisis inducida por ejercicio en adolescentes chilenos / Exercise-induced rhabdomyolysis in Chilean adolescents

Rabdomiolisis es la destrucción de las fibras musculares y se caracteriza clínicamente por dolor, edema y debilidad muscular, orina color rojo-café (mioglobinuria) y la elevación por un corto período de la enzima creatinquinasa en sangre. Entre las múltiples causas de rabdomiolisis está el ejercicio intenso. La rabdomiolisis inducida por el ejercicio está escasamente documentada en la población pediátrica y en general requiere descartar alguna patología metabólica de base. Las complicaciones de la rabdomiolisis pueden ser múltiples y graves: falla renal, arritmias cardíacas, síndrome compartamental, coagulación intravascular diseminada, acidosis láctica, etc. La falla renal es consecuencia de la necrosis tubular aguda secundaria al taponamiento de los túbulos renales por la mioglobina, que puede llegar a ser fatal. Comunicamos nuestra experiencia con tres adolescentes que después de iniciar un programa de entrenamiento físico, desarrollaron intenso dolor y edema muscular constatándose un significativo aumento de la enzima creatinquinasa y edema muscular en la ultrasonografía de los músculos utilizados en el ejercicio. El estudio complementario descartó una patología metabólica de base en todos ellos. El tratamiento oportuno incluyó terapia sintomática e hidratación intravenosa. No se desarrolló insuficiencia renal en ninguno. Frente al incremento no controlado del entrenamiento físico, el diagnóstico oportuno de esta patología permite evitar sus graves consecuencias.

Rhabdomyolysis implies injury to the muscle fibers. The hallmark clinical manifestations are pain, oedema, muscle weakness and dark urine (myoglobinuria). There is an increase, for a short time, of the muscle enzyme creatine kinase in blood. Exercise induced rhabdomyolysis is one of various causes of rhabdomyolysis but has been rarely documented in the pediatric population. In general it is always important to exclude an underlying metabolic pathology. Complications of rhabdomyolysis can be many and severe: renal failure, cardiac arrhythmias, compartment syndrome, disseminated intravascular coagulation, lactic acidosis, etc.. Renal failure is the consequence of the acute tubular necrosis secondary to the obstruction of the renal tubules by myoglobin, which can become fatal. We report our experience with three adolescents that after starting a program of physical training, developed intense pain and muscle oedema at the ultrasound scan of the muscles involved in the exercise. Complementary studies excluded an underlying metabolic disease in all of them. The opportune treatment included symptomatic treatment and endovenous hydratation. Fortunately, none of them developed renal failure.

Early diagnosis of malignant hyperthermia and its treatment regimen without dantrolene / 第二军医大学学报

Objective: To discuss the early diagnosis of malignant hyperthermia (MH) and its treatment regimen without dantrolene. Methods: A patient of American Society of Anesthesiologist class I had sudden muscle spasms and masseter muscle spasm during induction of anesthesia for idiopathic scoliosis surgery, and was diagnosed as having MH. Without using dantrolene, the patient was treated promptly with removal of inducement, control of temperature, adequate oxygen supply, maintaining of pH, water and electrolyte balance, and protection of renal function. The dynamic changes of the myoglobin in the blood and urine, serum creatine kinase, the blood gas indicators, and EtCO2, together with the pathological changes of the quadriceps were observed. Our experience on diagnosis and treatment was summarized. Results: The patient fully recovered and was discharged without any complications. The myoglobin in the blood and urine, serum creatine kinase and its isoenzyme increased rapidly and reached the peak one hour after MH, and maintained for about ten hours, then returned gradually to normal level about five days later. The temperature and EtCO2, increased immediately after development of MH, arterial blood gas quickly showed hypercapnic acidosis, but pH maintained normal or partial alkali during the treatment due to sodium bicarbonate administration; the alkali maintained obviously higher. Some quadriceps muscle cell had vacuolar degeneration and lysis. Conclusion: Non-ventilation induced increase of EtCO2 is a reliable indicator for early diagnosis of MH. Anesthetics, such as succinylcholine, should be avoided in patients at high risk of MH, and EtCO2 should be monitored. Once MH is diagnosed, dantrolene is the first choice. When without dantrolene, satisfactory outcome can be achieved through early diagnosis, timely removal of incentives, control of temperature, adequate oxygen supply, maintaining of stable internal environment, control of arrhythmia and protection of renal function.

A clinical study on Duchenne muscular dystrophy

No abstract available.