Clinical analysis of 29 children with rhabdomyolysis / 中国小儿急救医学

ABSTRACT

Objective To evaluate the predisposing factors and clinical features of rhabdomyolysis (RM) in children and to investigate the differences in therapeutic effect between blood purification treatment and conventional hydration alkalization treatment.Methods This retrospective analysis included clinical feature,predisposing factors,laboratory examination and complications of 29 RM cases from February 2010 to October 2012 in pediatric intensive care unit of Beijing Children's Hospital.We also compared the differences in therapeutic effects between blood purification treatment and conventional hydration alkalization treatment.Results The clinical features of RM in children was not typical.Infectious diseases were the most common cause of RM in children (55.2％,16/29),followed with congenital and inherited metabolic diseases (17.2％,5/29),drug induced diseases (3 cases),poisoning,diabetic ketoacidosis,electrical injury,strenuous exercise and unknown cause (1 case respectively).Among the laboratory tests,blood creatine kinase (CK)was significantly increased,accompanied by electrolyte imbalances including hypocalcemia,hypokalemia,hypophosphatemia.Sixteen cases (55.2％,16/29) had acute kidney injury (AKI).AKI group had significantly higher CK values than those without AKI (13 cases) [(54 106 ±57 542) IU/L vs (16 507 ± 13 284) IU/L,P =0.002].Blood purification enhanced the CK clearance.As compared with hydration alkalization group(11 cases),blood purification group(6 cases) showed a shorter time duration for a 50％ reduction in creatinine clearance [2.0 (1.5 ～ 2.5) d vs 3.5 (2.0 ～ 5.0) d,P =0.015].Blood purification group also had a shorter time duration for CK lowering below 2000 IU/L,but the difference was not statistically significant [4.0 (3.5 ～9.0) d vs 8.0(6.0 ～ 12.0) d,P =0.062].Conclusion Infectious diseases are the most common cause for RM in children;AKI and electrolyte imbalance are common complications;blood purification therapy makes CK drop faster than hydration alkalization treatment.