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1. Causes of Rhabdomyolysis Ri ???
2. Classification of Rhabdomyolysis
3. Other Medical Cause Drugs and toxins
Muscle hypoxia
Metabolic and endocrine disorders
Viral and bacterial infections
Temperature alterations
Miscellaneous
4. Drugs and Toxins Particularly alcohol, cocaine, drugs of abuse, and cholesterol-lowering agents, notably the stains
The most common medical cause (80%)
Primary drug-induced rhabdomyolysis should be distinguished from cases in which exposure to a drug or toxin leads to prolonged coma and immobility with ensuing muscle compression, ischemia, and necrosis
5. Drugs and Toxins Metabolic
Hypokalemia
Ischemia
Autoimmune
Membrane effect
Agitation
Neuroleptic malignant syndrome
Serotonergic syndrome
Mechanism uncertain
6. Drugs and Toxins: Metabolic Anticholinergics; antidepressants (all classes); antihistamines (diphenhydramine, doxylamine); arsenic; azathioprine; barbiturates; benzodiazepines; bezafibrate; carbon monoxide; clofibrate; cytotoxics; ethanol; ethylene glycol; fenfluramine; gemfibrozil; glutethamide; interferon- ; methanol; naltrexone; opiates; propofol; oxprenolol; labetolol; paracetamol; podophyllin; statins; zidovudine; isolated limb perfusion (multiple agents); streptokinase; alteplase
7. Drugs and Toxins Hypokalemia:
Amphotericin; carbenoxolone; glycirrhizate (licorice); itraconazole; laxative abuse; methylxanthines (caffeine, theophylline); thiazides and other kaliuretics
Ischemia:
?-Aminocaproic acid; cocaine; vasopressin
8. Drugs and Toxins Autoimmune:
Cyclosporin; famotidine; levodopa; nonsteroidals; penicillamine; phenylbutazone; phenytoin; trimethoprim-sulfamethoxazole
Membrane effect:
Carbon tetrachloride; cimetidine; colchicine; didanosine; dyes; gasoline; hydrocarbons; herbicides; iron dextran; metal fumes; quinidine; solvents; detergents; succinylcholine; toluene; vecuronium, pancuronium (especially combined with high-dose steroids); snake/spider/hornet/bee/fugu/parrotfish venoms
9. Drugs and Toxins Agitation:
Hemlock (? quail eaters); ketamine; lithium; loxapine; LSD; mercuric chloride; phencyclidine; salicylates; strychnine; terbutaline
Neuroleptic malignant syndrome:
Butyrophenones; levodopa and dopamine agonist withdrawal; lithium; phenothiazines; pimozide; promethazine; thioxanthenes
10. Drugs and Toxins Serotonergic syndrome
Amphetamines; Ecstasy; lithium; monoamine oxidase inhibitors; nefazodone; pethidine; selective serotonin reuptake inhibitors; tricyclic antidepressants; tryptophan; venlafaxine
Mechanism uncertain
Amiodarone; blowpipe dart poisoning; chromium picolinate; Haff disease; isoniazid; kidney beans; lamotrigine; nicotinic acid; peanut oil; pentamidine; valproate
11. Muscle Hypoxia External weight; prolonged immobility (including coma, Parkinson's disease); exaggerated lithotomy position and other surgical positions; pseudo-crush syndrome (torture victims, child abuse); pneumatic antishock garment
Arterial occlusion; compartment syndrome; cardiopulmonary bypass; vena cava ligation; disseminated intravascular coagulation; sickle cell disease; air embolism; atrial myxoma; diabetes mellitus; increased capillary permeability syndrome
12. Metabolic and Endocrine Disorders Particularly hypokalemia and hypophosphatemia
Diabetic ketoacidosis; nonketotic hyperglycemic/hyperosmolar states; hyper/hyponatremia; hypothyroidism; near drowning; renal tubular acidosis; pancreatitis; Crohn's disease with elemental diet
13. Infection Viral
Adenovirus; cytomegalovirus (CMV); Coxsackie; Enterovirus; Epstein-Barr (EBV); human immunodeficiency virus (HIV); herpes simplex (HSV); influenza A and B; measles; Varicella zoster
Bacterial
Other
14. Infection Viral
Bacterial
Bacillus spp.; Borrelia burgdorferi; Brucella; Campylobacter; Clostridia; Coxiella; Escherichia coli; Enterobacter; Francisella tularensis; H. influenzae; Legionella; Leptospira; Listeria; Salmonella; Shigella; Staphylococcus; Streptococcus; tetanus; typhoid; Vibrio
Other
15. Infection Viral
Bacterial
Other
Aspergillus; Candida; Mycoplasma; Plasmodium; Toxoplasma; Trichinella
16. Temperature Alterations Particularly heat stroke, malignant hyperthermia, and neuroleptic malignant syndrome
17. Miscellaneous Inflammatory and autoimmune muscle disease
Polymyositis; dermatomyositis; vasculitides; carcinoma (paraneoplastic necrotizing myopathy)
Exertion
Status epilepticus; delirium; psychosis; prolonged cardiopulmonary resuscitation; status asthmaticus; tetanus; prolonged myoclonus, dystonia or chorea