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Forensic Science, Medicine and Pathology

, Volume 14, Issue 4, pp 424–431 | Cite as

Rhabdomyolysis observed at forensic autopsy: a series of 52 cases

  • Hsuan-Yun Hu
  • Shyh-Yuh Wei
  • Chih-Hsin Pan
Original Article

Abstract

Rhabdomyolysis is characterized by skeletal muscle injury resulting in the release of intracellular proteins (such as myoglobin) and electrolytes into the blood circulation, which cause acute kidney injury, myoglobinuria and electrolyte imbalances. Clinical diagnosis of rhabdomyolysis is made on the basis of biochemical analysis; however, for forensic autopsies, biochemical data are often not available, and it is necessary to diagnose rhabdomyolysis via histopathological examinations. This study analyzed 52 cases with rhabdomyolysis and applied myoglobin immunohistochemistry to kidney, urine and blood samples. We found that blunt force injuries were the most common cause of rhabdomyolysis across all age groups, and drugs were the second most common cause. The drugs included ketamines, amphetamines, synthetic cathinones, entheogens, benzodiazepines, opioid analgesics, and anesthesia. Less than 60% of our cases had biochemical data, including myoglobin (92.5~416,978 ng/mL), creatine kinase (220~774,015 U/L), potassium (1.6~10.3 meq/L), calcium (2.7~29.2 mg/dL), and phosphorus (2.6~14.2 mg/dL). In the kidney tissue sections, we found that 95% of the rhabdomyolysis cases were positive for myoglobin immunohistochemistry and that 96% were associated with acute tubular necrosis. Our findings describe the features of fatal rhabdomyolysis in a large series and suggest that myoglobin immunohistochemistry can be used in post-mortem blood and urine cell blocks to detect myoglobin.

Keywords

Forensic autopsy Rhabdomyolysis Immunohistochemistry Cytology Myoglobin 

Notes

Acknowledgements

This study was supported by grants (103-1301-05-05-03, 104-1301-05-05-06 and 105-1301-05-05-01) from the Ministry of Justice, Taiwan.

Funding

This study was supported by grants (103–1301–05-05-03, 104–1301–05-05-06 and 105–1301–05-05-01) from Ministry of Justice, Taiwan. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

No conflict of interest to declare.

Ethical approval

This article does not contain any studies with animals performed by any of the authors.

Informed consent

The article does not include participants for whom informed consent was required.

Supplementary material

12024_2018_3_MOESM1_ESM.pdf (102 kb)
Supplementary Table 1 (PDF 101 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute of Forensic Medicine, Ministry of JusticeNew Taipei CityTaiwan
  2. 2.Department of Psychiatry, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan

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