Blog - INTERNET MÉDICA

Rabdomiólise Online (Rhabdomyolisis)

Por Paulo Leite 22/08/2019

¨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

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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

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■ Rhabdomyolisis secondary to systemic lúpus erythematosus

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

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

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■ 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

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

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

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

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

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■ Rhabdomyolysis after high intensity resistance training

Sakiko Honda, Tatsuya Kawasaki, Tadaaki Kamitani, Keisuke Kiyota

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■ Risk factors for exertional rhabdomyolysis with renal stress

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

Louise Dunphy, Rossel Morhij, Sarah Tucker

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■ Severe asymptomatic rhabdomyolysis complicanting a mycoplasma pneumoni

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■ Rhabdomyolysis in a patient with severe hypothyroidism

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■ Perspectives on exertional rhabdomyolisis

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

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

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

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

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

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

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■ 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

Gastroenterologia Infantil: Artigos de Revisão Online (Pediatrics Gastroenterology: Reviews)

Por Paulo Leite 21/08/2019

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■ Eficacia de la intervención nutricia y de la activida física en niños y adolescentes con hígado graso no alcohólico associado a obesidade: revisión sistemática exploratória

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