ABSTRACT

Rhabdomyolysis is a syndrome that can cause life threatening serious complications. It is characterized by the damage of skeletal muscles due to traumatic, toxic or metabolic factors leading to disposition of intracellular ingredients into the intravascular bed. When the etiological causes are analyzed at least one or more risk factors can frequently be found in critically ill children requiring intensive care admission. In this study, we evaluated the etiologic factors, clinical course and prognosis of rhabdomyolysis in critically ill children who are admitted to Akdeniz University Pediatric Intensive Care Unit (PICU).

Serum CK and myoglobulin values of 219 children who were admitted to PICU of Akdeniz University Hospital during the year 2011 were reviewed using electronic records. Those with 5 fold increase in either CK or myoglobulin values were enrolled to the study. Demographic data, laboratory values, organ failures, and prognosis of these patients were analyzed.

Rhabdomyolysis was observed in 11 patients (5%). Asphyxia and perfusion abnormalities were the most common reasons for rhabdomyolysis. Average length of stay in PICU was 10 days (range 2 – 34 days) and average length of mechanical ventilation was 8 days (1 – 34 days). Eight of the patients had a known chronic illness on the admission to PICU. None of them developed serious hypocalcaemia or hyperkalemia. Eight of the 11 patient (%72) had acute renal injury according to RIFLE criteria and hemodialysis was undertaken in 3 of them. Six out of 11 patients (54%) died. Of the patients who died three (50%) had physical findings of acute congestive heart failure.

According to this retrospective analysis; rhabdomyolysis was mostly associated with perfusion abnormalities in the critically ill child who needed PICU admission. Length of stay at PICU and mechanical ventilation was not different from general population in this study. When rhabdomyolysis was accompanied by acute renal injury and acute congestive heart failure, the mortality increased. Presence of congestive heart failure was a factor that limited the use of standard treatment options like urine alkalization, hydration and mannitol.

Keywords: Rhabdomyolysis, intensive care, myoglobin, acute kidney injury