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Causes of Rhabdomyolysis

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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


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