What is the most appropriate next step to confirm the diagnosis of rhabdomyolysis in this patient?

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1. What is the most appropriate next step to confirm the diagnosis of rhabdomyolysis in this patient? Provide an explanation for your answer.
Getting a blood test is the only way to be certain. The only reliable test for rhabdomyolysis is repeated blood tests for the muscle protein creatine kinase (CK or creatine phosphokinase [CPK]) in which a medical professional can check CK levels in blood when muscle tissue is harmed and when the muscle protein CK is released into the blood (Kodadek et al., 2022). In this patient’s case there is no more testing is necessary because it is generally agreed that a CK level larger than 5 to 10 times the upper limit of normal, as in the case of our patient, it is adequate to demonstrate the presence of rhabdomyolysis in this situation.
2. What is the most likely etiology of this patient’s recurrent rhabdomyolysis?
It is most likely an etiology of recurrent episodes of rhabdomyolysis in this patient, coupled with a reduced capacity for exertion when feeling well, clearly point to a metabolic abnormality. According to Joshi & Zierz, fatty acid oxidation is the main way that muscles get their energy during extended activity, fasting, and illness, but CPT-II deficiency is the condition that causes repeated rhabdomyolysis the most often (2022). The accumulation of acylcarnitine, which are necessary intermediates in the transport of long-chain fatty acids from the cytosol to the mitochondria for b-oxidation, can be utilized to identify certain metabolic diseases.
3. Rhabdomyolysis is a rapid breakdown of muscle. Detail the pathophysiology behind rhabdomyolysis.
An increase in intracellular free ionized calcium as a result of either cellular energy exhaustion or direct plasma membrane rupture is the pathophysiological hallmark of the condition in which trauma, ischemia, medications, toxins, metabolic problems, and infections are some of Rhabdomyolysis main causes (Kodadek et al., 2022). Rhabdomyolysis happens when the muscle tissue sustains direct physical trauma, ATP is depleted, and the muscle tissue membrane is damaged known as sarcolemma (Kodadek et al., 2022).
4. What are the possible complications of rhabdomyolysis?
The majority of patients experience acute kidney injury, which is the most severe complication of rhabdomyolysis in the days after initial presentation, in which other rhabdomyolysis complications include kidney damage or kidney failure, abnormal electrolyte levels, metabolic acidosis, compartment syndrome, and disseminated intravascular coagulation (Kodadek et al., 2022). According to Kodadek et al., one sign of rhabdomyolysis is red or dark urine, which patients frequently mistake for blood. Myoglobin, a toxin that can harm the kidneys, is what appears to be blood. When this occurs, your illness has worsened and you should seek medical attention right soon, according to him (2022).
5. Which medications may cause rhabdomyolysis?
Medications can result in rhabdomyolysis and is brought on by pressure-induced ischemia brought on by prolonged immobility, which is caused by general anesthetics and drug overdoses with CNS depressants such opioids, cyclic antidepressants, benzodiazepines, antihistamines, and barbiturates (Wen et al., 2029). According to Wen et al., medications such as antipsychotics, antidepressants, and antivirals can tear down muscle and rhabdomyolysis can also result from using statin drugs, particularly if you have diabetes or liver illness (2019).
References
Joshi, P. R., & Zierz, S. (2020). Muscle Carnitine Palmitoyltransferase II (CPT II) Deficiency: A Conceptual Approach. Molecules (Basel, Switzerland), 25(8), 1784. https://doi.org/10.3390/molecules25081784
Kodadek, L., Carmichael Ii, S. P., Seshadri, A., Pathak, A., Hoth, J., Appelbaum, R., Michetti, C. P., & Gonzalez, R. P. (2022). Rhabdomyolysis: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document. Trauma surgery & acute care open, 7(1), e000836. https://doi.org/10.1136/tsaco-2021-000836
Wen, Z., Liang, Y., Hao, Y., Delavan, B., Huang, R., Mikailov, M., Tong, W., Li, M., & Liu, Z. (2019). Drug-Induced Rhabdomyolysis Atlas (DIRA) for idiosyncratic adverse drug reaction management. Drug discovery today, 24(1), 9–15. https://doi.org/10.1016/j.drudis.2018.06.006