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Rhabdomyolysis Symptoms
When the muscles overheat, they accumulate large amounts of calcium in their cells. This activates enzymes, which in turn kills the cells. The residue of the cells is then released into the bloodstream and filtered out by the kidneys. One compound of the dead cells is myoglobin. Just as cholesterol can congest your blood vessels, myoglobin clogs up the fine canals in the kidneys. Once the myoglobin breaks down, it becomes toxic. Both effects, the clogging and the toxicity, may lead to kidney damage or failure.
Rhabdomyolysis treatment (Wikipedia)
The main therapeutic measure is hyperhydration (by administering intravenous fluids), and if necessary the use of osmotic diuretics (to prevent fluid overload). Alkalinisation of the urine with bicarbonate reduces the amount of myoglobin accumulating in the kidney.
As the electrolytes are frequently deranged, these may require correction, especially hyperkalemia (elevated potassium levels in the blood). Calcium levels are initially low (hypocalcemia), as circulating calcium precipitates in the damaged muscle tissue, presumably with phosphate released from intracellular stores. When the acute renal failure resolves, vitamin D levels rise rapidly, causing hypercalcemia (elevated calcium). Although this resolves eventually, high calcium levels may require treatment with bisphosphonates (e.g. pamidronate). If the exacerbating cause includes overdose of skeletal muscle relaxants and/or tricyclic antidepressants the treatment protocols include Gastric decontamination since it is fairly effective because the Anticholinergic effects of tricyclics and cyclobenzaprine delay gastric emptying and therefore it becomes possible to obtain tablet residues even after significant time elapse. Ventricular arrhythmias QRS widening, or intraventricular conduction abnormalities should be treated with sodium bicarbonate 1 meq/kg IV bolus and repeated if arrhythmias persist this should be followed by IV infusion of sodium bicarbonate to produce an arterial pH of 7.5. The mechanism of action of sodium bicarbonate is unknown.
Another marathon runner breaks down at the finishing line and is rushed to the hospital
for treatment. Chances are that the athlete has overheated some muscles and suffers
from a potentially life-