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Toxicant-Induced Rhabdomyolysis

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Critical Care Toxicology

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Abstract

The first known reference to rhabdomyolysis is said to be in the Bible in the Book of Numbers, [1] in which an illness is described that occurred in Israelites after eating hemlock-fed quail. Rhabdomyolysis is a potentially life-threatening syndrome that can develop from a variety of causes. The term “Rhabdomyolysis” literally translates to “dissolution of striped [skeletal] muscle.” It is the final common pathway of a number of different processes, all of which end in skeletal muscle injury. An elevated plasma creatinine kinase (CK) level is the most sensitive laboratory finding pertaining to muscle injury; whereas hyperkalemia, acute kidney injury, and compartment syndrome represent the major life-threatening complications [2]. The clinical and biochemical syndrome of rhabdomyolysis occurs when skeletal muscle cell disruption causes release of muscle cell contents (CK, lactate dehydrogenase, aldolase, myoglobin, purines, potassium, and phosphates) into the interstitial space and plasma. Although direct mechanical trauma, compression, excessive muscle activity, and ischemia are frequent causes, direct xenobiotic-induced rhabdomyolysis results from toxic insult to the cell membrane, affecting its ability to maintain ion gradients. Although rhabdomyolysis does not indicate irreversible necrosis of muscle, life-threatening illness and multi-organ insufficiency may result [3, 4].

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Authors and Affiliations

  1. Department of Emergency Medicine for the Kaiser Permanente South Sacramento Medical Center, Kaiser Permanente Northern California Regional Toxicology Service, Sacramento, CA, 95823, USA

    G. Patrick Daubert

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  1. G. Patrick Daubert
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Correspondence to G. Patrick Daubert .

Editor information

Editors and Affiliations

  1. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Jeffrey Brent

  2. Office of New Drugs Drug Evaluation and Research, FDA, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas' Hospital, London, United Kingdom

    Paul Dargan

  4. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Benjamin Hatten

  5. Med & Toxicological Intensive Care Unit, Lariboisière Hospital Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Robert Palmer

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

  1. I

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2

    Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.

  4. II-3

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III

    Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.

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Daubert, G.P. (2017). Toxicant-Induced Rhabdomyolysis. In: Brent, J., Burkhart, K., Dargan, P., Hatten, B., Megarbane, B., Palmer, R. (eds) Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-20790-2_106-2

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  1. Latest

    Toxicant-Induced Rhabdomyolysis
    Published:
    23 March 2017

    DOI: https://doi.org/10.1007/978-3-319-20790-2_106-2

  2. Original

    Rhabdomyolysis
    Published:
    14 October 2016

    DOI: https://doi.org/10.1007/978-3-319-20790-2_106-1

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