Treatment and prognosis of patients with nontraumatic rhabdomyolysis

Introduction

Nontraumatic rhabdomyolysis is not frequent in an internal-neurological ICU and there are few reports of aetiology, clinical course, therapy and outcome of patients with severe rhabdomyolysis. We analyzed our patients with nontraumatic rhabdomyolysis to evaluate therapeutic strategies and prognostic parameters.

Methods

In a retrospective study we analyzed the hospital reports of patients with nontraumatic rhabdomyolysis admitted to our internal-neurological ICU during a 12-year period (1986–1997).

Results

Thirty-four patients were admitted during the study period (incidence 1: 416). The average age of the patients was 35.2 years (27 male, 7 female patients). The most frequent causes for nontraumatic rhabdomyolysis were drug intoxication (35.3%), strenuous exercise (26.5%), infections (17.6%) and seizures (11.7%). The average level of creatine phosphokinase (CK) was 16234 U/l. All patients were treated by intravenous fluids for volume repletion and by alkalinization of the urine, dialysis was required in six patients (17.6%) for control of uremic symptoms. Seven patients (20.5%) were treated by plasma exchange to reduce rapidly excessive CK-levels in order to prevent acute renal failure. Two patients died in septic MOF after drug-induced rhabdomyolysis and delayed hospital admission (mortality 5.9%). After ICU-stay three patients showed peripheroneural lesions, all other patients (85.3%) recovered without sequelae.

Conclusion

Nontraumatic rhabdomyolysis has a good prognosis if the patients are admitted early to the hospital for treatment. Plasma exchange seems to be an effective therapy to prevent acute renal failure. Septic MOF after rhabdomyolysis has a poor prognosis.