Rhabdomyolysis Case Study

History: Martha Wilmington, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath ("dyspnea") upon exertion. She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she's had a decreased appetite, some nausea and vomiting, and tenderness in the right upper quadrant of the abdomen.

Amid the physical exam, your specialist will check your joints for swelling, redness and warmth. He or she will likewise check your reflexes and muscle quality.

Severe weakness, fatigue, weight loss, symptoms suggestive of a possible hypoglycemia, nausea and vomiting, circulatory collapse, suggest to secondary hypoadrenalism.

Rhabdomyolysis results when the skeletal muscle rapidly breaks down and releases myoglobin into the bloodstream. Myoglobin is a protein that composes muscle cells that carry and store oxygen in the muscles. Therefore, when myoglobin is released into the bloodstream, the skeletal muscle rapidly deteriorates and is rapidly being destroyed. Rhabdomyolysis can lead to renal kidney failure. Renal kidney failure is when the kidneys can’t remove waste and urine. In some cases, rhabdomyolysis can lead to death. However, there is treatment for rhabdomyolysis.

Rhabdomyolysis is the breakdown of muscle fibers due to injury. The injury may come from physical damage to the muscle like an injury but other causes are:

The most likely diagnosis for this patient is rhabdomyolysis. Rhabdomyolysis is “ the rapid breakdown of muscle that causes the release of intracellular contents, including protein pigment myoglobin, into the extracellular space and bloodstream”(McCance & Huether, 2014, p. 1540). This condition is occurs when there is damage to the skeletal muscle and can have life-threating complications.

Potassium levels were also increasing (6.8) and his urea and creatinine were markedly deranged. He also began to appear grossly oedematous.

Rheumatic Fever is an inflammatory disease, caused by strep A when it is not cured correctly. About five percent of patients that have not been treated for strep A develop Rheumatic Fever. The immune system of a person with this disease is attacking bacteria, but also good tissue, usually on the heart. Children ages six to sixteen are most likely to get this. There is a high chance of dying from the disease if not cured correctly. Some symptoms may include; inflamed joints, fever, weakness, chest pain, rashes, chorea (abnormal movements/jolts) plus more. The diagnosis of Rheumatic fever involves a series of examinations by multiple doctors, looking closely at the symptoms of the patient and doing things such as chest x rays and heart monitors.

Some people complain of a loss of balance, this is probably because the muscles become unable to compensate for an off-balance posture. Serious injury from tripping and falling down is a common risk with Inclusion Body Myositis. In addition severe muscle pain is another commonly noted symptom. The diagnosis for IBM, although difficult, simply because the symptoms may be caused by other illnesses, is based on clinical signs and subsequent testing. Many tests can help diagnose the disease , including a blood test that screens for creatine kinase or CK levels. The result of muscle cell damage is the blood enzyme CK. High CK levels would then show strange muscle damage. An electromyography, which is a technique for recording the electrical activity of muscles, can be used to recognize characteristic abnormalities. The best way to diagnose Inclusion Body Myositis , however, is a muscle biopsy, where a small sample of muscle is removed for laboratory analysis (IBM illnessopedia,n.d.,para 3) . Muscle resonance imaging scans may also reveal changes in the muscles. (Travers, P. ,2010, June 17)

Rhabdomyolysis is rare. The muscle tissue breaks down and releases myoglobin in the blood. This can damage the kidneys. Some symptoms include dark urine, muscle aches, and weakness. Fewer than two hundred thousand cases

Acute kidney injury (AKI) is a common clinical issue but the understanding of the syndrome has been re-evaluated, standardised and aprimorated in the past years. The change from acute renal failure to AKI happened due the fact the even mild change in function or structure of the kidney can cause abrupt clinical manifestations such as change in extracellular volume and electrolytes balance and inability to properly excrete nitrogenous waste products like urea. The old terminology is used now saved for cases were renal replacement therapy is been considered due to severity. The AKI diagnostic criteria is based in a 48 hour creatinin serum level rise by 0.3mg/dL or 1.5 times the patient baseline level or urine decrease to a volume less than

pyogenes are not common if treated within an appropriate time period. Some common complications that could arise however are cervical lymphadenitis, peritonsillar (retropharyngeal abscess), sinusitis, otitis media, meningitis, bacteraemia, endocarditis and pneumonia. (7) Abscesses are the accumulation of pus within an inflamed area. Otitis media is when parts of the middle ear are inflamed causing problems with your auditory abilities. Meningitis is inflammation of the meninges layer protecting the brain. Bacteraemia is the spread of bacteria within an individuals blood. Endocarditis occurs when the endocardium layer of the heart is inflamed. (6) Most of these complications arise when the pathogen spreads into deeper layers within our body through lymphatic fluid or blood (7). An important complication that is usually caused by a erythrogenic toxin. This toxin acts as a superantigens and can be present the first time someone encounters this ifection. Symptoms of Scarlet fever are pink rash on the superficial layers of the skin, strawberry tongue that is inflamed and a fever. Further complications following scarlet fever are glomerulonephritis and rheumatic fever. Glomerulonephritis effects the kidneys and causes inflammation. Rheumatic fever effects the heart and is not infectious. When an individual has rheumatic fever, antibodies produced to the pathogenic antigen cross react with our own tissues, specifically heart tissue. This

Rhabdomyolysis is defined as: “a clinical and biochemical syndrome that occurs when skeletal muscle cells disrupt and release creatinine phosphokinase (CK), lactate dehydrogenase (LDH), and myoglobin in the interstitial space and plasma.” (Althay, Bezerra, Loborio & Daher, 2008. p. 721). The breakdown of muscle will set forth the release of the guts, per say, of the cell which will also pertains to myoglobin. It is this myoglobin that will occlude the tubules, this occlusion will lead to injury of the kidney’s nephron. (Huether & McCane, 2017. p. 997). It is stipulated by Althayd et al. that when the patient is not hypovolemic that myoglobin is less caustic to the

Urine samples could be requested to test for blood in the urine and haemosiderin levels (Hoffbrand, Moss and Pettit, 2006). If these are increased, it supports the laboratory findings of HUS. A prothrombin time test and a partial prothrombin time test are performed to analyse the time it takes blood to clot and is useful in the diagnosis of Disseminated Intravascular Coagulation (Kumar, Aster and Robbins, 2012).

Typical presentations of rheumatic fever (RF) include a history of sore throats, head aches, fever, abdominal pain, nausea and vomiting, swollen glands and other common signs and symptoms of streptococcal infection (Porth & Matfin, 2009). The presentation of RF can be acute, recurrent or chronic. The acute stage