¨A rabdomiólise se caracteriza por necrose muscular, que resulta na liberação para a circulação de constituintes do músculo, entre eles a mioglobina. Tipicamente, a rabdomiólise se apresenta com mialgia, fraqueza muscular e urina escura. As manifestações clínicas podem variar desde uma doença assintomática até uma condição de risco à vida com enzimas muito elevadas, insuficiência renal aguda (IRA) e distúrbios eletrolíticos. Comumente, os níveis de creatinoquinase estão acentuadamente elevados, e pode haver a presença de mioglobinúria. As doenças infecciosas são as principais causas de rabdomiólise em crianças. No entanto, são possíveis outras etiologias, como trauma, exercícios, fármacos, toxinas, e distúrbios metabólicos e eletrolíticos. Distúrbios hereditários do metabolismo de carboidratos, deficiências de enzimas da cadeia respiratória mitocondrial, distúrbios da oxidação de ácidos graxos e deficiência de carnitina-palmitoil transferase são exemplos de doenças metabólicas associadas à rabdomiólise. Elevação da CPK (valores de 500 a 1000 U/L são usados para definir a rabdomiólise) e mioglobínúria está presente em50 a 75% dos pacientes. As principais abordagens terapêuticas consistem em: evitar a manutenção da lesão muscular (corrigir a causa base), prevenção da lesão renal, além de identificação e medidas rápidas para as complicações com risco de morte (hipercalemia). A principal medida é iniciar uma reposição volêmica vigorosa para prevenção da insuficiência renal aguda. O bicarbonadosato pode ser utilizado para alcalinizar a urina, e desta forma reduzir os riscos de obstrução tubular pela mioglobina.¨

 

■ How to do it: investigate exertional rhabdomyolysis (or not)

Peter M Fernandes, Richard J Davenport

Pract Neurol. 2019 Feb; 19(1): 43–48

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580786/

 

■ A case of severe rhabdomyolysis associated with secondary adrenal insufficiency and autoimune hepatitis

Lisa Kennedy, Sureshkumar Nagiah

BMJ Case Rep. 2019; 12(3): e227343

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453326/

 

■ Rhabdomyolisis secondary to systemic lúpus erythematosus

Daniel Nguyen, Farah Alsaati, Jena Deitrick, Kamel Azhar, Evelyn Sbar

Auto Immun Highlights. 2018 Dec; 9(1): 5.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5886906/

 

■ Transaminases and creatine kinase ratios for differentiating delayed acetaminophen overdose from rhabdomyolysis

Joshua B. Radke, Douglas A. Algren, James A. Chenowe

West J Emerg Med. 2018 Jul; 19(4): 731–73

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040894/

 

■ Rhabdomyolysis with different etiologies in childhood

Demet Alaygut, Meral Torun Bayram, Belde Kasap et al

World J Clin Pediatr. 2017 Nov 8; 6(4): 161–168

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5691034/

 

■ Rhabdomyolysis after co-administration of a statin and fusidic acid: an analysis of the literature and of the WHO database of adverse drug reactions

Thomas Deljehier, Antoine Pariente, Ghada Miremont‐Salamé et al

Br J Clin Pharmacol. 2018 May; 84(5): 1057–1063

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903256/

 

■ Rhabdomyolysis: patterns, circumstances, and outcomes of patients presenting to the emergency department

Emily G. Knafl, James A. Hughes, Goce Dimeski, Rob Eley

Ochsner J. 2018 Fall; 18(3): 215–221

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6162117/

 

■ Assessment of the risk of rhabdomyolysis and myopathy during concomitant treatment with ticagrelor and statins

Dorota Danielak, Marta Karaźniewicz-Łada, Franciszek Główka

Drugs. 2018; 78(11): 1105-1112

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6061431/

 

■ Rhabdomyolysis following initiation of antiviral therapy with oseltamivir

Harika Puttagunta, Saleh Alghsoon, Prudhvi Regula et al

Am J Case Rep. 2018; 19: 673–677

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029519/

 

■ Influenza-induzed rhabdomyolysis

Martin Runnstrom, Alex M Ebied, Adonice Paul Khoury, Raju Reddy

BMJ Case Rep. 2018; 11(1): e22661

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301448/

 

■ Rabdomiólise como manifestação de uma doença metabólica: relato de caso

Moniz, Marta Sousa et al

Rev. bras. ter. intensiva, Mar 2017, vol.29, no.1, p.111-114

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-507X2017000100111&lng=pt&nrm=iso

 

■ Rhabdomyolysis after high intensity resistance training

Sakiko Honda, Tatsuya Kawasaki, Tadaaki Kamitani, Keisuke Kiyota

Intern Med. 2017 May 15; 56(10): 1175–1178

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491812/

 

■ Risk factors for exertional rhabdomyolysis with renal stress

Terje Apeland, Tore Danielsen, Eva M Staal, et al

BMJ Open Sport Exerc Med. 2017; 3(1): e000241

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680435/

 

■ Rhabdomyolysis-induced compartment syndrome secondary to atorvastatin and strenuous exercise

Louise Dunphy, Rossel Morhij, Sarah Tucker

BMJ Case Rep. 2017; 2017: bcr2016218942

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372158/

 

■ Severe asymptomatic rhabdomyolysis complicanting a mycoplasma pneumoni

Alex Gosselt, Jobien Olijhoek, Thomas Wierema

BMJ Case Rep. 2017; 2017: bcr2016217752

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5612003/

 

■ Rhabdomyolysis in a patient with severe hypothyroidism

Nooshin Salehi, Endre Agoston, Iqbal Munir, Gary J. Thompson

Am J Case Rep. 2017; 18: 912–918

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574522/

 

■ Perspectives on exertional rhabdomyolisis

Eric S. Rawson, Priscilla M. Clarkson, Mark A. Tarnopolsky

Sports Med. 2017; 47(Suppl 1): 33–49

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371628/

 

■ Levofloxacin-induced rhabdomyolysis: a case report

Febin John, Ruby Oluronbi, C. S. Pitchumoni

J Med Case Rep. 2016; 10(1): 235.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997698/

 

■ Resistance exercise-induced rhabdomyolysis: need for immediate intervention and proper counselling

M A Khalil, B R Saab

Australian Family Physician 2016, vol 45 (12): 898-901

https://www.racgp.org.au/afp/2016/december/resistance-exercise%E2%80%93induced-rhabdomyolysis-need-for-immediate-intervention-and-proper-counselling/

 

■ Beyond muscle destruction: a systema review of rhabdomyolysis for clinical practice

Luis O. Chavez, Monica Leon, Sharon Einav, Joseph Varon

Crit Care. 2016; 20: 135

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908773/

 

■ Rabdomiólisis severa tras una agresión física y agravada por anfetaminas.

Heras, Manuel et al.

Rev.Colomb.Reumatol., Mar 2016, vol.23, no.1, p.44-46

http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0121-81232016000100007&lng=en&nrm=iso

 

■ Insuficiencia renal aguda inducida por rabdomiolisisInsuficiência renal aguda induzida por rabdomiólise.

Nieto-Rios, John Fredy, Vega-Miranda et al

Iatreia, Jun 2016, vol.29, no.2, p.157-16

http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0121-07932016000200005&lng=en&nrm=iso&tlng=es

 

■ Sickle cell trait, rhabdomyolysis, and mortality among U.S.Army soldiers

  1. Alan Nelson, Patricia A. Deuster, Robert Carter, et al

N Engl J Med. 2016 Aug 4; 375(5): 435–442

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5026312/

 

■ Exertional rhabdomyolysis: physiological response or manifestation of an underlying myopathy?

Renata S Scalco, Marc Snoeck, Ros Quinlivan et al

BMJ Open Sport Exerc Med. 2016; 2(1): e000151

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5117086/

 

■ Rabdomiólise com altos níveis de creatinofosfoquinase, sem evolução para insuficiência renal

I B Rabelo, C P D dos Santos, E M Caldeira et al

Rev Soc Bras Clin Med 2016, vol 14 (1): 38-40

http://docs.bvsalud.org/biblioref/2016/05/19/38-40.pdf

 

■ Rhabdomyolysis and exercise-associated hyponatremia in ultra-bikers and ultra-runners

Daniela Chlíbková, Beat Knechtle, Thomas Rosemann et al

J Int Soc Sports Nutr. 2015; 12: 29

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480906/

 

■ Diagnostic evaluation of rhabdomyolisis

Jessica R. Nance, Andrew L. Mammen

Muscle Nerve. 2015 Jun; 51(6): 793–810

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4437836/

 

■ Rhabdomyolysis: pathogenesis, diagnosis, and treatment

P A Torres, J A Helmstetter, A M Kaye

Ochsner 2015, vol 15 (1): 58-69

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365849/

 

■ Rabdomiólise recorrente secundária à hiponatremia em doente com polidipsia psicogênica primária

Aguiar, Diana Tavares, Monteiro, Catarina and Coutinho, Paula

Rev Bras Ter Intensiva, Mar 2015, vol.27, no.1, p.77-81

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-507X2015000100077&lng=pt&nrm=iso

 

■ Fenofibrate-induced rhabdomyolysis in an adolescent with chronic renal failure and hypothyroidism

Marques, Filipa Carlota, Viveiro, Carolina and Castro, Isabel

Port J Nephrol Hypert, Sept 2014, vol.28, no.3, p.249-253

http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S0872-01692014000300008&lng=pt&nrm=iso&tlng=en

 

■  Dr Paulo Fernando Leite

Cardiologia/Prevenção Cardiovascular

Estratificação de Risco Cardiovascular

Consultório: Rua Padre Rolim 815/sala 601

Tel: 33245518 (Consulta Particular/Unimed)

– Centro Médico Unimed BH/Contagem/Pedro I

Belo Horizonte/MG/Brasil

CRMMG: 7026

Email: pfleite1873@gmail.com