Rhabdomyolysis due to multiple fire ant bites a case report

Prasad, Anushre; Kumar, Ranjeet; Ramanan, Harini; Khandige, Nalini; Prabhu, Krishnananda

doi:10.1016/s2222-1808(12)60091-7

Cited by 2 publications

(4 citation statements)

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“…14 8 Laporan kasus yang dipublikasi mengenai kejadian rabdomiolisis sangat bervariasi, antara lain akibat program latihan fisik di rumah dengan intensitas tinggi, 15 infeksi virus Dengue, 16 HIV, 3 parainfluenza, 17 penggantian statin (penggunaan atorvastatin digantikan dengan simvastatin), 18 ingesti black rock (sejenis henna), 19 dan gigitan semut api. 20…”

Section: Etiologiunclassified

“…Cedera sarkolema dapat diakibatkan secara langsung oleh trauma (contoh: crush injury) atau tidak langsung melalui kekurangan ATP dalam serat otot (contoh: latihan fisik berat). 4 3,4,20 Kurangnya ATP menyebabkan disfungsi pompa ion Na + /K + ATPase dan Ca 2+ ATPase sarkolema, sehingga terjadi influks cairan dan elektrolit (termasuk Na + dan Ca 2+ ) yang berakibat terjadi edema serat dan peningkatan kalsium intrasel oleh aktivitas 2Na + /Ca 2+ exchanger, 3,4,20 kontraksi otot yang menetap, aktivasi enzim proteolitik protease netral (antara lain calpain) dan fosfolipase A 2 yang mendegradasi membran fosfolipid (sarkolema dan membran mitokondria) dan organela intrasel, serta berbagai molekul vasoaktif yang berlanjut dengan pembentukan radikal bebas. 1,4 Disolusi enzimatik dari fosfolipid membran akan melepaskan lisofosfatida dan asam lemak bebas yang berefek toksik terhadap sarkolema dan membran intrasel lainnya; sebagai akibat, terjadi disfungsi protein carrier pada membran serat otot dan masuknya Ca 2+ ke dalam sitoplasma.…”

Section: Patofisiologiunclassified

“…Gambaran klinis rabdomiolisis bervariasi dari yang ditemukan melalui pemeriksaan laboratorik (subklinis) sampai dengan kegawatdaruratan. 3,4,20 Gejala klinis klasik dari rabdomiolisis ialah kelemahan anggota gerak, mialgia, pembengkakan dan disfungsi otot, kaku dan kesemutan, serta urin berwarna teh atau coklat kemerahan (mioglobinuria).…”

Section: Gambaran Klinisunclassified

“…1,9 Peningkatan CK melebihi 5 kali batas atas normal telah mengindikasikan suatu rabdomiolisis. 3,9,20,21 Menurut the Clinical Advisory on Statins, untuk mendiagnosis suatu rabdomiolisis diperlukan gejala klinis gangguan otot, peningkatan CK 10 kali lipat dari nilai normal atas, serta peningkatan kreatinin dan nefropati yang disertai urin berwarna teh. 14 Degradasi jaringan dan pelepasan CK berlangsung lambat.…”

Section: Diagnosisunclassified

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Rabdomiolisis

Wangko¹

2014

JBM

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Literally, rhabdomyolysis is the occurence of skeletal muscle destruction, resulting in massive liberation of muscle fiber constituents (electrolytes, myoglobin, creatine kinase, and other sarcoplasmic proteins) into the extracellular fluid and the blood circulation. The etiological spectrum of rhabdomyolysis is extensive, consisting of: physical factors such as trauma and compression, ischemia of skeletal muscle tissue, strenuous physical exercise, prolonged immobilization, high-voltage electrical injury, hyperthermia; and non-physical factors such as metabolic myopathy (genetic disorders), drugs and toxins, viral and bacterial infections, electrolyte and endocrin abnormalities, connective tissue disorders; and unknown causes. Although the causes of rhabdomyolysis vary extensively, the histopathological findings usually show a loss of cell nuclei and muscular striation with the absence of inflammatory cells. The pathophysiology of rhabdomyolysis includes changes in cellular metabolism, reperfusion injury, and the compartment syndrome. The degrees of rhabdomyolysis vary from a subclinical rise of creatinine kinase to an emergency condition with multiorgan failure. Classically, the clinical findings are muscular aches and swelling, as well as dysfunction, stiffness, numbness, weakness, and tea-colored urine. The most important laboratory examinations are serum creatinine kinase, besides serum and urine myoglobin. The life-threatening complications of rhabdomyolysis are hypovolemia, arrhythmia and cardiac arrest, acute kidney injury, and DIC. Its early diagnosis and prompt management are very important to the progress of the patient as well as to the effective control of rhabdomyolysis. Medical personnel, pharmacists, sport/gym instructors, and athletes have to be aware of the signs and symptoms of this rhabdomyolysis. Keywords: rhabdomyolysis, electrolytes, myoglobin, creatine kinase Abstrak: Rabdomiolisis adalah terjadinya destruksi serat otot rangka yang berakibat terlepasnya konstituen serat otot (elektrolit, mioglobin, kreatin kinase, dan protein sarkoplasma lainnya) ke dalam cairan ekstrasel dan sirkulasi. Penyebab rabdomiolisis multifaktorial, terdiri dari: faktor fisik, antara lain trauma dan kompresi, iskemia jaringan otot, latihan fisik berat, imobilisasi berkepanjangan, paparan listrik bertegangan tinggi, hipertermia; faktor non-fisik, antara lain miopati metabolik (genetik), obat-obatan dan toksin, infeksi virus dan mikroba, gangguan elektrolit dan endokrin, kelainan jaringan ikat; dan penyebab yang tidak diketahui. Walaupun penyebab rabdomiolisis sangat bervariasi, gambaran histologik yang ditemukan umumnya berupa hilangnya inti serat otot dan corak serat, tanpa disertai adanya sel-sel radang. Patofisiologi rabdomiolisis yaitu perubahan metabolisme sel, cedera reperfusi, dan sindroma kompartemen. Derajat rabdomiolisis dapat bervariasi dari peningkatan kreatin kinase subklinis sampai yang memerlukan penanganan darurat disertai kegagalan multiorgan. Gejala klinis klasik berupa nyeri, pembengkakan dan disfungsi otot, kaku, kesemutan, kelemahan, serta urin berwarna teh. Pemeriksaan penunjang utama yaitu kreatin kinase serum, serta miogobin urin dan serum. Komplikasi yang sangat mengancam kehidupan ialah hipovolemia, aritmia dan gagal jantung, gagal ginjal akut, serta DIC. Diagnosis dini dan penanganan segera sangat berperan dalam perlangsungan rabdomiolisis dan prognosis pasien. Tenaga medis, tenaga farmasi, instruktur olah raga dan gym perlu diwaspadai terhadap gejala rabdomiolisis. Kata kunci: rabdomiolisis, elektrolit, mioglobin, kreatin kinase

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Section: Etiologiunclassified

Section: Patofisiologiunclassified

Section: Gambaran Klinisunclassified

Section: Diagnosisunclassified

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Rabdomiolisis

Wangko¹

2014

JBM

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Unraveling Complexities: Rhabdomyolysis, Acute Renal Injury, and Compartment Syndrome Following a Wasp’s Sting

Kurmana,

Kumhar,

Tiwari

et al. 2024

Cureus

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This study delves into the rare occurrence of rhabdomyolysis induced by wasp stings, emphasizing its toxic systemic repercussions. Drawing parallels with documented instances of insect bites worldwide, including those by honey bees and Africanized bees, the research explores the correlation between multiple wasp stings and acute renal failure associated with rhabdomyolysis. The venom’s active components, such as amines, kinins, and histamine-releasing peptides, underpin toxic systemic reactions, leading to hemolysis, coagulopathy, and severe cytotoxicity-induced acute renal failure. Noteworthy is the emergence of blackish necroses at the sting site, suggesting intense cytotoxicity. The study also highlights skin necrosis as a prognostic indicator for toxic systemic reactions. The presented case manifests an anaphylaxis-like reaction, revealing insights into toxic responses devoid of IgE-mediated allergic reactions. Timely intervention, encompassing hydration, transfusion, and dialytic support, proves imperative in scenarios involving multiple wasp stings, offering successful outcomes documented through plasma exchange in severe cases. This research prompts considerations beyond anaphylaxis, urging exploration of severe toxic systemic reactions in the context of multiple wasp stings.

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Rhabdomyolysis due to multiple fire ant bites a case report

Cited by 2 publications

References 10 publications

Rabdomiolisis

Rabdomiolisis

Unraveling Complexities: Rhabdomyolysis, Acute Renal Injury, and Compartment Syndrome Following a Wasp’s Sting

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