Rhabdomyolysis Pathophysiology & Nursing Diagnosis?

Hello, everyone, Welcome to the understanding of Rhabdomyolysis. In this post, we will try to answer the question: what is Rhabdomyolysis and causes of it, causes symptoms, diagnosis, and treatment of Rhabdomyolysis?

Rhabdomyolysis (also known as “rhabdo”) is a potentially life-threatening condition that can occur when the skeletal muscles are injured or damaged.

Main Causes of Rhabdomyolysis

Causes of rhabdomyolysis include:

Injury or trauma:  A severe burn, electrocution, or crushing injury can cause sudden muscle damage. The most common cause is a crush injury.

High-intensity exercise: Engaging in an exercise program too quickly can lead to rhabdomyolysis when the muscles don’t have enough time to heal after an intense workout.

Severe dehydration and overheating: Heat causes faster muscle breakdown. Without sufficient fluids, your kidneys can’t efficiently dispose of waste from your body.

Medications: Certain medications like antipsychotics, antidepressants, antivirals, and statins (especially for diabetes or liver disease) may trigger rhabdomyolysis.

Substance use disorder: Toxic substances such as heroin, LSD, cocaine, and alcohol can cause muscle deterioration.

Long periods of inactivity: People who cannot get up long after falling or losing consciousness may develop rhabdomyolysis.

Certain medical conditions: Conditions like McArdle disease and Duchenne muscular dystrophy that are genetic and specific metabolic or mitochondrial disorders can increase the risk of rhabdomyolysis.

Other causes 

• infection
• septic shock
• electrolyte imbalances
• snake venom.

Symptoms

• Muscle pains
• weakness
• vomiting
• confusion.

There may be tea-colored urine or an irregular heartbeat.

Rhabdomyolysis Pathophysiology

Rhabdomyolysis is a severe condition that can cause severe damage to the kidneys and other organs. When muscle cells are damaged, they release myoglobin into the bloodstream. This protein travels to the kidneys, where it can be filtered and removed from the body through urine. Too much myoglobin accumulates in the kidneys can lead to renal failure.

Additionally, the breakdown of damaged muscle cells can lead to electrolyte abnormalities, which can be dangerous if left untreated.

Furthermore, releasing cell contents from the affected muscles into the bloodstream can cause an inflammation response in other organs and tissues. This can result in further organ damage or dysfunction.

What Happens to Muscles during Rhabdomyolysis?

Rhabdomyolysis can result in your muscle fibers breaking down and decaying, releasing components into the bloodstream. These elements may be present in large quantities:

• Potassium – Hyperkalemia causes severe cardiac dysfunction ranging from palpitations to ventricular fibrillation. Additionally, hyperkalemia causes significant muscle weakness that can progress to total paralysis.
• Phosphate – High phosphate levels can cause the mineralization of organs, leading to tissue injury and organ failure.
• Myoglobin – In the bloodstream, myoglobin causes kidney injury by blocking the tubules in the kidneys. It also causes damage to other organs like the liver and an inflammatory response throughout the body.
• Creatine Kinase (CK): This enzyme is released from damaged muscles. Elevated concentrations of CK can be seen in the blood and urine with rhabdomyolysis.
• Urate – High urate levels increase the risk for gout, kidney stones, hyperuricemia (“gouty arthritis”), and other health problems.

Your kidneys filter out and eliminate unwanted components from your blood. If too many of these components accumulate in the body, they can cause damage to the kidneys and potentially lead to kidney failure, which is a life-threatening condition. To prevent this, it’s essential that your kidneys can quickly process and excrete wastes from your body so that they don’t have a chance to build up.

Treatment

Treatment for rhabdomyolysis addresses the underlying cause, restoring electrolyte balance and protecting the kidneys from damage. This may include:

Intravenous fluids: Intravenous (IV) fluids help to support kidney function by providing hydration and maintaining electrolyte balance. They also reduce inflammation and prevent dehydration.

Medications: Medications may be prescribed to address electrolyte imbalances, reduce inflammation, and protect the kidneys from damage.

Surgery or wound care: If there is an underlying cause of rhabdomyolysis, such as an injury or surgery, it must be addressed accordingly.

Rest and activity modification: Rest allows time for muscles to heal and reduces the risk of further injury. Your doctor may recommend a period of reduced activity while you recover.

Follow-up care: Regular appointments with your doctor will be necessary to track your progress and monitor any complications from rhabdomyolysis.

It’s important to talk to your doctor if you have any symptoms associated with rhabdomyolysis, as it can quickly become a life-threatening condition if left untreated. Your doctor can recommend the best course of treatment to help you recover and reduce your risk for complications.

Complications of Rhabdomyolysis

The following are the most common complications of rhabdomyolysis:

• Kidney damage: The myoglobin can block off the kidneys’ tubules, causing acute renal failure. This can lead to a need for dialysis or even organ transplants.
• Electrolyte imbalances: Electrolyte imbalance can lead to abnormal heart rhythms and other serious problems.
• Liver failure: The release of cells into the bloodstream can cause inflammation in the liver, resulting in acute liver failure.
• Sepsis: The breakdown of muscle cells can trigger a systemic inflammatory response, leading to sepsis.
• Muscle weakness and wasting: Long-term rhabdomyolysis can lead to muscle wasting, decreased strength, and difficulty performing everyday tasks.
• Repeated episodes of rhabdomyolysis may also increase your risk for chronic muscle pain and fatigue.
• Disseminated intravascular coagulation: This is a condition where the blood clots abnormally, leading to bleeding and organ damage. 
• Complications from medications: Certain medications used to treat rhabdomyolysis can cause adverse reactions, contributing to further complications.
• Compartment syndrome:  This condition is caused by increased muscle compartment pressure, which can lead to nerve and tissue damage.

Nursing Care Plan for Rhabdomyolysis

Assessment

• Monitor vital signs closely, including temperature, heart rate, respiratory rate, and blood pressure.
• Assess for muscle pain or weakness and any other symptoms of rhabdomyolysis.
• Diagnostic imaging, such as ultrasound or computerized tomography (CT) scans to detect any evidence of muscle damage.
• Cognitive assessment to check for any neurological disturbances caused by the condition.
• Check the patient’s urine output and color for evidence of myoglobinuria.
• A full set of vitals, including blood pressure, temperature, and pulse.

Rhabdomyolysis nursing diagnosis

Some of the nursing diagnoses for rhabdomyolysis include:

• Risk for electrolyte imbalance
• Imbalanced nutrition: less than body requirements
• Impaired physical mobility
• Pain related to muscle damage and swelling
• Risk for infection
• Risk for poor skin integrity
• Knowledge deficit about the disease process, medications, and lifestyle modifications
• Risk for fluid volume deficit.

Outcomes

• The patient will demonstrate an understanding of the disease and treatment.
• The patient will maintain electrolyte balance within normal range.
• The patient will report adequate pain relief.
• The patient will be able to move all extremities without difficulty or pain.

Interventions 

• Provide the patient with information about the disease process, medications used for treatment, and lifestyle modifications that can help prevent future episodes.
• Monitor the patient’s vital signs, including temperature, heart rate, respiratory rate, and blood pressure.
• Assess for muscle pain or weakness and any other symptoms of rhabdomyolysis.
• Administer medications to reduce inflammation and pain as prescribed by the physician.
• Encourage the patient to rest and avoid activities that may worsen their condition.
• Encourage the patient to maintain a healthy diet of fruits, vegetables, whole grains, and lean proteins.
• Monitor for signs of electrolyte imbalance, such as nausea, vomiting, muscle cramps, or confusion.
• Instruct the patient on recognizing early signs of rhabdomyolysis or impending renal failure.
• Provide measures to prevent skin breakdowns, such as frequent position changes and the use of a pressure-relieving mattress.
• Assess for knowledge deficits related to the disease process, medications, and lifestyle modifications.
• Encourage the patient to drink plenty of fluids to prevent dehydration.
• Monitor urine output and color for evidence of myoglobinuria.

Rationales

The interventions aim to lower the chance of complications and help with the recovery process. This is achieved through:

• Relieving pain allows the patient to move better and thus reduces the risk of muscle contracture and joint immobility.
• Providing nutrition to prevent dehydration and malnutrition.
• Preventing infections by early detection and proper therapy.

Evaluation

• The patient has demonstrated an understanding of the disease and treatment.
• The patient’s electrolyte levels are within normal range.
• The patient can move all extremities without difficulty or pain.
• The patient reports adequate pain relief.
• The patient is adhering to prescribed lifestyle modifications.

Final Words

The pathophysiology of rhabdomyolysis is complex and involves a variety of physiological processes. Understanding this condition’s signs, symptoms, and complications is essential to provide early diagnosis and effective treatment. With the right interventions, patients can manage their symptoms and reduce their risk of serious complications. It is also essential to educate patients about the disease process; medications used to treat rhabdomyolysis, and lifestyle modifications to help prevent future episodes.

References

• https://en.wikipedia.org/wiki/Rhabdomyolysis#Mechanism
• https://my.clevelandclinic.org/health/diseases/21184-rhabdomyolysis