Myoglobinuria Clinical Presentation

Updated: Dec 21, 2018
  • Author: Prasad Devarajan, MD, FAAP; Chief Editor: Craig B Langman, MD  more...
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Presentation

History

The classical triad of symptoms of rhabdomyolysis includes myalgia, muscle weakness, and dark urine. The typical history may include drug use, coma, trauma, or strenuous exercise. Patients who use diuretics and develop severe potassium deficiency may be predisposed to rhabdomyolysis.

Some patients may provide a history of viral illnesses, fever, convulsions, electric shock, burns, crush injuries, or trauma of any type. Patients may have a history of sepsis, especially sepsis that affects muscle tissue, such as gas gangrene. Others may give a history of participation in organized athletics during the summer or in strenuous exercise during athletic events, such as bicycle races or mountain climbing.

The use of some prescription drugs, such as azidothymidine (AZT) or lovastatin, or the ingestion of ethylene glycol may predispose individuals to myoglobinuria. Other drugs associated with myoglobinuria include heroin, codeine, barbiturates, amphetamines, licorice, diazepam, amphotericin-B, phencyclidine, and some dietary supplements.

Acute tumor lysis syndrome may be associated with myoglobinuria.

Snakebites, bites from recluse spiders, and multiple insect stings can cause muscle necrosis.

Ingestion of quail can precipitate myoglobinuria.

Autoimmune vesiculitis, such as dermatomyositis, may destroy muscle tissue.

Recurrent myoglobinuria was reported in a 14-year-old girl with Becker muscular dystrophy. [17]

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Physical Examination

Physical examination reveals generalized muscle weakness, often with painful muscle groups, trauma, and/or areas of ischemic pressure necrosis when the patient has laid down for extended periods.

Expect any patient with extensive trauma to have some myoglobinuria.

The volume status of the patient should be carefully and quickly determined because volume depletion necessitates rapid correction in order to prevent acute renal failure.

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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.

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