¨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.¨
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■ Dr Paulo Fernando Leite
Cardiologia/Prevenção Cardiovascular
Estratificação de Risco Cardiovascular
Consultório: Rua Padre Rolim 815/sala 601
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