eMedicine Specialties > Pediatrics: General Medicine > Nephrology

Myoglobinuria: Follow-up

Author: Prasad Devarajan, MD, Louise M Williams Endowed Chair in Pediatrics, Professor of Pediatrics and Developmental Biology, Director of Nephrology and Hypertension, Director of Clinical Nephrology Laboratories, Chief Executive Officer of Dialysis Unit, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine
Coauthor(s): Watson C Arnold, MD, Director, Department of Pediatric Nephrology, Cook Children's Medical Center
Contributor Information and Disclosures

Updated: Jul 27, 2009

Follow-up

Further Inpatient Care

  • Hemodialysis or continuous veno-veno hemodialysis (CVVHD) may be needed to treat acute renal insufficiency in patients with myoglobinuria. Recovery often occurs in 10-14 days.
  • Electrolyte complications of rhabdomyolysis, including hyperkalemia and hypocalcemia, may need immediate treatment.
  • In the recovery phase, patients may develop hypercalcemia as calcium precipitated in damaged tissue returns to the circulation.
  • Long-term diuresis may cause hypokalemia.

Further Outpatient Care

  • Patients may need extensive rehabilitation for muscle damage.

Deterrence/Prevention

  • Patients with metabolic muscle diseases must avoid trauma, overexertion, dehydration, and heat injuries.

Complications

  • The most serious complication of myoglobinuria is acute renal failure.
  • Other complications can result from renal shutdown or from the intracellular products released into the system by rhabdomyolysis.

Prognosis

  • Patients with uncomplicated cases of myoglobinuria recover without sequelae.

Patient Education

  • Patients who develop exercise-induced rhabdomyolysis need education in maintaining adequate fluid intake, in oral rehydration, and in pacing their exercise in hot weather or extreme conditions.

Miscellaneous

Medicolegal Pitfalls

  • Monitor the patient with a crush injury or extensive muscle damage for rhabdomyolysis and acute renal failure.
  • Administer fluids to a dehydrated patient or any patient with possible muscle injury until the degree of severity is determined.
  • Warn patients against stressful exercise.
 


More on Myoglobinuria

Overview: Myoglobinuria
Differential Diagnoses & Workup: Myoglobinuria
Treatment & Medication: Myoglobinuria
Follow-up: Myoglobinuria
Multimedia: Myoglobinuria
References
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References

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  3. Mannix R, Tan ML, Wright R, Baskin M. Acute pediatric rhabdomyolysis: causes and rates of renal failure. Pediatrics. Nov 2006;118(5):2119-25. [Medline].

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  7. Brown CV, Rhee P, Chan L, et al. Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference?. J Trauma. Jun 2004;56(6):1191-6. [Medline].

  8. David WS. Myoglobinuria. Neurol Clin. Feb 2000;18(1):215-43. [Medline].

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  11. Kilfoyle D, Hutchinson D, Potter H, George P. Recurrent myoglobinuria due to carnitine palmitoyltransferase II deficiency: clinical, biochemical, and genetic features of adult-onset cases. N Z Med J. Feb 25 2005;118(1210):U1320. [Medline].

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Further Reading

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Keywords

rhabdomyolysis, acute renal failure, ARF, hyperkalemia, hypocalcemia, myoglobinuria, tubular obstruction, acute renal insufficiency, crush injury, muscle necrosis, viral myositis, connective tissue disease, hyperkalemia, hypocalcemia, multiorgan failure, potassium deficiency, sepsis, acute tumor lysis syndrome, autoimmune vesiculitis, dermatomyositis, ischemic pressure necrosis, external myolysis, gas gangrene, tetanus, Legionnaire disease, shigellosis, coxsackie viral infections, diabetic ketoacidosis, myxedema, nonketotic hyperosmolar comas, McArdle syndrome, muscular dystrophy, polymyositis, myophosphorylase, phosphofructokinase, phosphohexoisomerase deficiency, Reye syndrome

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Contributor Information and Disclosures

Author

Prasad Devarajan, MD, Louise M Williams Endowed Chair in Pediatrics, Professor of Pediatrics and Developmental Biology, Director of Nephrology and Hypertension, Director of Clinical Nephrology Laboratories, Chief Executive Officer of Dialysis Unit, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine
Prasad Devarajan, MD is a member of the following medical societies: American Heart Association, American Society of Nephrology, American Society of Pediatric Nephrology, National Kidney Foundation, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Coauthor(s)

Watson C Arnold, MD, Director, Department of Pediatric Nephrology, Cook Children's Medical Center
Watson C Arnold, MD is a member of the following medical societies: American College of Medical Quality, American Federation for Medical Research, American Society for Nutritional Sciences, American Society of Nephrology, American Society of Pediatric Nephrology, International Society of Nephrology, Sigma Xi, Southern Society for Pediatric Research, Texas Medical Association, and Texas Pediatric Society
Disclosure: Nothing to disclose.

Medical Editor

Laurence Finberg, MD, Clinical Professor, Department of Pediatrics, University of California at San Francisco and Stanford University
Laurence Finberg, MD is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Frederick J Kaskel, MD, PhD, Director of the Division and Training Program in Pediatric Nephrology, Vice Chair, Department of Pediatrics, Montefiore Medical Center and Albert Einstein School of Medicine
Frederick J Kaskel, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Pediatric Society, American Physiological Society, American Society of Nephrology, American Society of Pediatric Nephrology, American Society of Transplantation, Eastern Society for Pediatric Research, Federation of American Societies for Experimental Biology, International Society of Nephrology, National Kidney Foundation, New York Academy of Sciences, Renal Physicians Association, Sigma Xi, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Howard Trachtman, MD, Program Director, Pediatrics Research, Schneider Children's Hospital, Department of Pediatrics, Division of Nephrology, Professor, Albert Einstein College of Medicine
Howard Trachtman, MD is a member of the following medical societies: American Society of Hypertension, American Society of Nephrology, American Society of Pediatric Nephrology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Craig B Langman, MD, The Isaac A Abt, MD, Professor of Kidney Diseases, Feinberg School of Medicine, Northwestern University; Division Head of Kidney Diseases, Children's Memorial Hospital, Chicago
Craig B Langman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Nephrology, and International Society of Nephrology
Disclosure: Amgen Grant/research funds None; Altus Pharmaceuticals Grant/research funds None; Genzyme Grant/research funds None; Merck Grant/research funds None; NIH Grant/research funds None

 
 
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