Acute rhabdomyolysis in the intensive care unit

Introduction

The aim of this clinical trial is to examine the factors that influence prognosis of acute rhabdomyolysis (ARM) in critically ill ICU patients.

Methods

We studied retrospectively 39 ICU patients with ARM. Mean age: 47.8 ± 24.5 years, mean stay: 20.3 ± 11.5 days. Underlying diseases: multiple trauma 26, complicated surgery 9, status epilepticus 2, drug poisoning 2. All patients underwent mechanical ventilation. Laboratory data included initial and peak values, as well as frequent measurements at least twice a day, of: serum creatinine (CR), creatine phoshokinase (CPK), blood urea nitrogen (BUN), potassium, sodium, calcium, magnesium, phosphate, white blood cell count (WBC), hematocrit (HT), transaminases, bilirubin, lactate dehydrogenase (LDH), and myoglobulin of urine and urine toxicology screen.

Results

Intensive therapy began very early upon diagnosis with intravenous administration of fluids, furosemide and/or mannitol and bicarbonates besides etiological treatment, where was possible. The initial value of CR was normal (≤ 1.3 mg%) in 22 patients (56.4%). The mean percentage decrease in HT was 13.1 ± 2.8% after 24 hours of hydration (showing approximately the percentage of initial volume depletion). In 11 patients (28.2%) CPK was >10,000 IU/l and in five patients (12.8%) > 20,000 IU/l. BUN ≤ 50 mg% was initially found in 20 patients (51.3%) and WBC <11,000/mm³ in 19 (48.7%). The urine pH (measured every 3–6 hours) had a value < 6.0 in two patients (5.1%), while 23 (59.0%) developed acute renal failure (ARF) and required hemodialysis. Mortality rates: 8/39 (20.5%).

Conclusion

(1) Normal initial CR, initial BUN < 50 mg%, initial WBC <11,000/mm³ and less than 15% decrease of HT (volume depletion) were associated with either normal renal function or a slight ARF not requiring hemodialysis (P < 0.05). (2) An elevated initial value of CPK >10,000 IU/l was associated with ARF requiring hemodialysis (P < 0.01) [1], longer duration of mechanical ventilation (P < 0.05), longer ICU stay (P < 0.05) and higher mortality rates (< 0.05). (3) Contrarily, high values of urine myoglobulin were not associated with severe ARF or elevated mortality rates (P < 0.1).