What are the indication to hospitalize rhabdomyolysis patients?

How is DIC a rhabdomyolysis complication?

 

The diagnosis of rhabdomyolysis is made based on history, physical and laboratory studies. The mechanism of injury/action varies from acute physical activity to infection. The severity of the disease can range from mild to severe based on laboratory testing and clinical presentation. In pediatric cases the most common cause of rhabdomyolysis usually involves some form of infection that causes breakdown in the muscles within the body. This breakdown leads to increase levels of myoglobin in the blood and can cause acute trauma to the kidneys. The indication for hospitalization is usually a clinical one based on CKP levels and kidney function. The mechanism of injury is probably the greatest determining factor for hospitalization. If rhabdomyolysis has occurred secondary to trauma hospitalization is almost always indicated. If complications of rhabdomyolysis have occurred such as compartment syndrome, arrhythmias or volume depletion (hypovolemia) hospitalization is likely required.

Monitoring laboratory findings is necessary to establish baseline organ function. Patients with severe cases of rhabdomyolysis based on laboratory studies, patient symptoms and physical exam symptoms will need hospitalization. This is on a case by case basis and involves review of I&Os, vitals (hypertension), CPK levels, BUN, creatinine, and potassium levels. Health care professionals can identify the severity of acute kidney injury by reviewing the labs and using the following staging for AKI:

Pediatric patients with rhabdomyolysis may have hypertension. This needs to be closely monitored as too high of a blood pressure could lead to systemic organ damage. The blood pressure, age, and percentile needs to identified to better provide management for the HTN. Patients with residual symptoms (visual acuity issues, kidney disease, etc.) may need more aggressive inpatient management and treatment.

Bottom line- there is no specific criteria for hospitalization for rhabdomyolysis, however there are guidelines and criteria based on other complications associated with rhabdomyolysis. Chiefly, the mechanism of injury is the most important indication for hospitalization for patients with rhabdomyolysis and kidney function is another.

DIC

There are a wide range of complications associated with rhabdomyolysis. One of which is DIC (disseminated intravascular coagulation). DIC is associated with rhabdomyolysis due to the release of thromboplastin and other prothrombotic substances. The pathogenesis is different based on the cause of the rhabdomyolysis. If the mechanism of action for rhabdomyolysis is infection then liposaccharides are released that causes active coagulation. If trauma is suspected, damage to epithelium may release coagulant enzymes leading to clotting cascade activation. DIC has its own list of complications, chiefly end organ damage may result from too much coagulation affecting the kidneys, liver and spleen.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3940504/pdf/303-312.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4584412/pdf/nihms713733.pdf

https://www.uptodate.com/contents/disseminated-intravascular-coagulation-in-infants-and-children?search=disseminated%20intravascular%20coagulation&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2

https://pediatrics.aappublications.org/content/pediatrics/140/3/e20171904.full.pdf