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Rhabdomyolysis: Diagnosis and Treatment in Bariatric Surgery

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Background

Rhabdomyolysis (RML) and subsequent acute renal failure can be serious problems following bariatric operations. Early diagnosis and treatment are important to avoid the complications of RML.

Methods

This review was achieved by searching the key words: Rhabdomyolysis, diagnosis, treatment and bariatric surgery.We included prospective, retrospective, case reports and review articles.

Results

RML diagnosis can be done by: signs and symptoms, physical evaluation, laboratory findings and imaging examinations. Muscle weakness, myalgia, decubitus ulcer, proteinuria and myoglobinuria are the more mentioned findings. Elevation of CPK levels is the most sensitive diagnostic evidence of RML. Treatment is geared toward preserving renal function by avoiding dehydration, hypovolemia, tubular obstruction, aciduria, and free radical release. Early recognition allows the administration of fluids, bicarbonate, and mannitol.

Conclusion

Prophylactic measures and early diagnosis and treatment of rhabdomyolysis in bariatric surgery are imperative to prevent the potential fatal complications of this condition.

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Abbreviations

RML:

Rhabdomyolysis

ARF:

Acute renal failure

CPK:

Creatine phosphokinase

AST:

Aspartate aminotransferase

ALT:

Alanine aminotranferease

LDH:

Lactate dehydrogenase

EMG:

Electromyographic

MRI:

Magnetic resonance imaging

CT:

Computed tomography

US:

Ultrasound

GFR:

Glomerular filtration rate

CVVH:

Continuous Venovenous Hemofiltration

BIC/MAN:

Bicarbonate and Mannitol

CPK MM:

Creatine phosphokinase MM-isoenzyme (muscle type)

CPK MB:

Creatine phosphokinase MB-isoenzyme (cardiac type)

References

  1. Singh D, Chander V, Chopra K. Rhabdomyolysis. Methods Find Exp Clin Pharmacol 2005; 27: 39–8.

    Article  CAS  PubMed  Google Scholar 

  2. Mognol P, Vignes S, Chosidow D et al. Rhabdomyolysis after laparoscopic bariatric surgery. Obes Surg 2004, 14: 91–.

    Article  PubMed  Google Scholar 

  3. Criner JA, Appelt M, Coker C et al. Rhabdomyolysis: the hidden killer. Medsurg Nurs 2002; 11: 138–3.

    PubMed  Google Scholar 

  4. Sulowicz W, Walatek B, Sydor A et al. Acute renal failure in patients with rhabdomyolysis. Med Sci Monit 2002; 8: 24–.

    Google Scholar 

  5. Vanholder R, Sever MS, Erek E et al. Rhabdomyolysis. J Am Soc Neph 2000; 11: 1553–1.

    CAS  Google Scholar 

  6. Zager RA. Rhabdomyolysis and myohemoglobinuric acute renal failure. Kidney Int 1996; 49: 314–6.

    Article  CAS  PubMed  Google Scholar 

  7. Torres-Villalobos G, Kimura E, Mosqueda JL et al. Pressure-induced rhabdomyolysis after bariatric surgery. Obes Surg 2003; 13: 297–01.

    Article  PubMed  Google Scholar 

  8. Bostanjian D, Anthone GJ, Hamoui N et al. Rhabdomyolysis of gluteal muscles leading to renal failure: a potentially fatal complication of surgery in the morbidly obese. Obes Surg 2003; 13: 302–.

    Article  PubMed  Google Scholar 

  9. Lagandre S, Arnalsteen L, Vallet B et al. Predictive factors for rhabdomyolysis after bariatric surgery. Obes Surg 2006; 16: 1365–0.

    Article  CAS  PubMed  Google Scholar 

  10. Criddle LM. Rhabdomyolysis. Pathophysiology, recognition, and management. Crit Care Nurs 2003 23: 14–2, 24–.

    Google Scholar 

  11. Sauret JM, Marinides G, Wang GK. Rhabdomyolysis. Am Fam Physic 2002; 65: 907–2.

    Google Scholar 

  12. Collier B, Goreja MA, Duke BE. Postoperative rhabdomyolysis with bariatric surgery. Obes Surg 2003; 13: 941–.

    Article  PubMed  Google Scholar 

  13. Wiltshire JP, Custer T. Lumbar muscle rhabdomyolysis as a cause of acute renal failure after Roux-en-Y gastric bypass. Obes Surg 2003; 13: 306–3.

    Article  PubMed  Google Scholar 

  14. Masuda A, Hirota K, Satone T et al. Pink urine during propofol anesthesia. Anesth Analg 1996; 83: 666–.

    Article  CAS  PubMed  Google Scholar 

  15. Khuara RN, Baudendistel TE, Morgan EF et al. Postoperative rhabdomyolysis following laparoscopic gastric bypass in the morbidly obese. Arch Surg 2004; 139: 73–.

    Article  Google Scholar 

  16. Polderman, KH. Acute renal failure and rhabdomyolysis. Int J Artif Organs 2004; 27: 1030–.

    CAS  PubMed  Google Scholar 

  17. Kim KK. Exogenous causes of myoglobinuria –review of 26 cases. J Korean Med Sci 1996; 11: 342–.

    CAS  PubMed  Google Scholar 

  18. Grover DS, Atta MG, Eustace JA et al. Lack of clinical utility of urine myoglobin detection by microconcentrator ultrafiltration in the diagnosis of rhabdomyolysis. Nephrol Dial Transplant 2004; 19: 2634–.

    Article  CAS  PubMed  Google Scholar 

  19. Harriston S. A review of rhabdomyolysis. Dimens Crit Care Nurs 2004; 23: 155–1.

    Article  PubMed  Google Scholar 

  20. Muckart DJ, Moodley M, Naidu AG et al. Prediction of acute renal failure following soft-tissue injury using the venous bicarbonate concentration. J Trauma 1992; 33: 813–.

    Article  CAS  PubMed  Google Scholar 

  21. Al-Shekhlee A, Hachwi R, Jaberi MM et al. The electromyographic features of acute rhabdomyolysis. J Clin Neuromusc Dis 2005; 6: 114–.

    Article  Google Scholar 

  22. De Freitas Carvalho DA, Valezi AC, de Brito EM et al. Rhabdomyolysis after bariatric surgery. Obes Surg 2006; 16: 740–.

    Article  PubMed  Google Scholar 

  23. Lamminen AE, Hekali PE, Tiula E et al. Acute rhabdomyolysis: evaluation with magnetic resonance imaging compared with computed tomography and ultrasonography. Br J Radiol 1989; 62: 326–0.

    Article  CAS  PubMed  Google Scholar 

  24. Messing ML, Feinzimer ET, Brosnan JJ et al. CT of rhabdomyolysis associated with malignant hyperthermia and seizures. Clin Imaging 1993; 17: 258–.

    Article  CAS  PubMed  Google Scholar 

  25. Russ PD, Dillingham M. Demonstration of CT hyperdensity in patients with acute renal failure associated with rhabdomyolysis. J Comput Assist Tomogr 1991; 15: 458–3.

    Article  CAS  PubMed  Google Scholar 

  26. Steeds RP, Alexander PJ, Muthusamy R et al. Sonography in the diagnosis of rhabdomyolysis. J Clin Ultrasound 1999; 27: 531–.

    Article  CAS  PubMed  Google Scholar 

  27. Nakahara K, Tanaka H, Masutani K et al. The value of computed tomography and magnetic resonance imaging to diagnose rhabdomyolysis in acute renal failure. Nephrol Dial Transplant 1999; 14: 1564–.

    Article  CAS  PubMed  Google Scholar 

  28. Sharon GC. Rhabdomyolysis. Orthop Nurs 2005; 24: 443–.

    Google Scholar 

  29. Pasnik K, Krupa J, Stanowski E et al. Successful treatment of gastric fistula following rhabdomyolysis after vertical banded gastroplasty. Obes Surg 2005; 15: 428–0.

    Article  PubMed  Google Scholar 

  30. Better OS, Stein JH. Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis. N Engl J Med 1990; 322: 825–.

    Article  CAS  PubMed  Google Scholar 

  31. Haskins N. Rhabdomyolysis and acute renal failure in intensive care. Nurs Crit Care 1998; 3: 283–.

    CAS  PubMed  Google Scholar 

  32. Filis D, Daskalakis M, Askoxylakis I et al. Rhabdomyolysis following laparoscopic gastric bypass. Obes Surg 2005; 15: 1496–00.

    Article  CAS  PubMed  Google Scholar 

  33. Abassi A, Hoffman A, Better O. Acute renal failure complicating muscle crush injury. Semin Nephrol 1998; 18: 558–5.

    CAS  PubMed  Google Scholar 

  34. Moghtader J, Brady WJ, Bonadio W. Exertional rhabdomyolysis in an adolescent athlete. Pediatr Emerg Care. 1997; 13: 382–.

    Article  CAS  PubMed  Google Scholar 

  35. Sinert R, Kohl L, Rainone T et al. Exercise-induced rhabdomyolysis. Ann Emerg Med 1994; 23: 1301–.

    Article  CAS  PubMed  Google Scholar 

  36. Slater MS, Mullins RJ. Rhabdomyolysis and myoglobinuric renal failure in trauma and surgical patients: a review. review. J Am Coll Surg 1998; 186: 693–16.

    Article  CAS  PubMed  Google Scholar 

  37. Curry SC, Chang D, Connor D. Drug- and toxininduced rhabdomyolysis. Ann Emerg Med 1989; 18: 1068–4.

    Article  CAS  PubMed  Google Scholar 

  38. Harper J. Rhabdomyolysis and myoglobinuric renal failure. Crit Care Nurse 1990; 10: 32–.

    CAS  PubMed  Google Scholar 

  39. Kruse D. “Tyson squats–as a cause of rhabdomyolysis. J Emerg Nurs 1998; 24: 116–.

    Article  CAS  PubMed  Google Scholar 

  40. Stroh C, Hohmann U, Remmler K et al. Rhabdomyolysis after biliopancreatic diversion with duodenal switch. Obes Surg 2005; 15: 1347–1.

    Article  CAS  PubMed  Google Scholar 

  41. Bocca G, Van Moorselaar JA, Feitz WFJ et al. Compartment syndrome, rhabdomyolysis and risk of acute renal failure as complications of the lithotomy position. J Nephrol 2002; 15: 183–.

    PubMed  Google Scholar 

  42. Melissas J, Kontakis G, Volakakis E et al. The effect of surgical weight reduction on functional status in morbidly obese patients with low back pain. Obes Surg 2005; 15: 378–1.

    Article  PubMed  Google Scholar 

  43. Faintuch J, de Cleva R, Pajecki D et al. Rhabdomyolysis after gastric bypass: severity and outcome patterns. Obes Surg 2006; 16: 1209–3.

    Article  PubMed  Google Scholar 

  44. Lane R, Phillips M. Rhabdomyolysis. BMJ 2003; 327: 115–.

    Article  PubMed  Google Scholar 

  45. Fai Li S, Zapata J, Tillen E. The prevalence of falsepositive cardiac tropinin I in ED patients with rhabdomyolysis. Am J Emerg Med 2005; 23: 860–.

    Article  Google Scholar 

  46. Ettinger JEMTM, Dos Santos PV, Azaro E et al. Prevention of rhabdomyolysis in bariatric surgery. Obes Surg 2005; 15: 874–.

    Article  Google Scholar 

  47. Better OS, Rubinstein I, Winaver JM et al. Mannitol therapy revisited (1940–997). Kidney Int 1997; 52: 886–4.

    Article  CAS  PubMed  Google Scholar 

  48. Homsi E, Barreiro MF, Orlando JM et al. Prophylaxis of acute renal failure in patients with rhabdomyolysis. Ren Fail 1997; 19: 283–.

    Article  CAS  PubMed  Google Scholar 

  49. Brown CV, Rhee P, Chan L et al. Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference? J Trauma 2004; 56: 1191–.

    Article  PubMed  Google Scholar 

  50. Swain R, Ross D. Lower extremity compartment syndrome. When to suspect acute or chronic pressure buildup. Postgrad Med 1999; 105: 159–2.

    Article  CAS  PubMed  Google Scholar 

  51. Smoszna J, Pietrzak B, Wankowicz Z. Acute kidney failure in the course of rhabdomyolysis with hemodialysis in personal material from 1995–999. Pol Merkeriusz Lek 2000; 9: 826–.

    CAS  Google Scholar 

  52. Acquarone N, Garibotto G, Pontremoli R et al. Hypernatremia associated with severe rhabdomyolysis. Nephron 1989; 51: 441–.

    Article  CAS  PubMed  Google Scholar 

  53. Ettinger JEMT, Marcílio de Souza CA, Ázaro E et al. Clinical features of rhabdomyolysis after open and laparoscopic Roux-en-Y gastric bypass. Obes Surg (accepted for publication).

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Authors and Affiliations

  1. Postgraduate Course of Medicine and Human Health, Escola Bahiana de Medicina, Bahia, Brazil

    João E. M. T. M. Ettinger MD & Carlos A. Marcílio de Souza MD, PhD

  2. Bariatric Surgery Division, Department of Surgery, Hospital São Rafael (HSR) and Hospital Cidade, Bahia, Brazil

    João E. M. T. M. Ettinger MD, Paulo V. Santos-Filho, Euler Azaro MD, PhD, Carlos A. B. Mello MD & Edvaldo Fahel MD, PhD

  3. Nephrology Division HSR, Salvador, Bahia, Brazil

    Paulo B. P. Batista MD, PhD

Authors
  1. João E. M. T. M. Ettinger MD
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  2. Carlos A. Marcílio de Souza MD, PhD
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  3. Paulo V. Santos-Filho
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Correspondence to João E. M. T. M. Ettinger MD.

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Ettinger, J.E.M.T.M., Marcílio de Souza, C.A., Santos-Filho, P.V. et al. Rhabdomyolysis: Diagnosis and Treatment in Bariatric Surgery. OBES SURG 17, 525–532 (2007). https://doi.org/10.1007/s11695-007-9091-5

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  • DOI: https://doi.org/10.1007/s11695-007-9091-5

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