Minor blunt injury-induced rhabdomyolysis from a road traffic accident in Nigeria.

Citation metadata

From: Nigerian Medical Journal(Vol. 61, Issue 2)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Article
Length: 2,007 words
Lexile Measure: 1440L

Document controls

Main content

Article Preview :

Byline: Ernest. Anyabolu, Innocent. Okoye, Innocent. Chukwuonye, Arthur. Anyabolu, Kenneth. Dike, Chinyelu. Ufoaroh

Rhabdomyolysis, though not a common complication of minor blunt trauma, may result in life-threatening acute kidney injury (AKI). Here is illustrated a case of a young male who sustained minor blunt injuries in a road traffic accident, which he overlooked and presented with features of severe AKI. The patient is a 24-year-old male, who presented with progressive weakness, difficulty in walking, and features of uremia, 14 days after he sustained minor blunt injuries and lacerations in a road traffic accident. Evaluation showed elevated serum creatine kinase, serum myoglobin, and severe azotemia. He was commenced on hemodialysis. He was also commenced on antibiotics, analgesic, and 5% dextrose/saline. He had three sessions of hemodialysis on alternate days. His condition improved remarkably after the first session of dialysis. He was discharged after 18 days on admission. Follow-up in the clinic showed a normal renal function. This case report shows rhabdomyolysis from minor blunt injuries sustained in a road traffic accident and complicated by severe AKI. The patient almost recovered full renal function with management.

Introduction

Rhabdomyolysis is a syndrome that derives from injuries to skeletal muscle.[1] Albeit the myriads nature of these injuries, rhabdomyolysis does not commonly result from common blunt injuries sustained in road traffic accidents.[1]

Injuries to the muscle cell, the sarcolemma, may disrupt many pumps like Na/K-ATPase, which regulates cellular electrochemical gradients.[2] Electrolyte composition is altered following energy depletion that disorganizes the cellular transport mechanisms.[3] Massive proteases and proteolytic enzymes that result from a rise in intracellular calcium, subsequently induce free oxygen radicals' regeneration. In turn, myofilaments are broken down by these substances and enzymes. Membrane phospholipids are also injured causing leakage of intracellular materials into the plasma. Creatine kinase (CK), phosphate, potassium, myoglobin, and urate are some of the materials unleashed into the plasma. Activated neutrophils and fluid infiltrate the muscles.[4] These will incite reperfusion injury and inflammatory cascade, which will cause perpetuation of the muscle breakdown.[5],[6]

In adults, rhabdomyolysis usually manifests with the triad of myalgia, muscle weakness, and dark urine.[7]

The incidence of rhabdomyolysis in Nigeria is not well defined. Myoglobin-induced rhabdomyolysis has not been well documented in Nigeria from the literature search, but worldwide, its incidence is conservatively put at 16%-33%.[8] Severe acute kidney injury (AKI) is a recognized complication of rhabdomyolysis.[9]

Levels of serum CK above 5 times the upper limit of normal establish the diagnosis of rhabdomyolysis.[10] Serum myoglobin may also be considered although this is not specific. Ancillary tests include high potassium levels and elevated lactate dehydrogenase.[1] Target treatment in rhabdomyolysis is the treatment of shock and reclamation of renal function.[11]

From the literature search, there was a paucity of reports on rhabdomyolysis from minor road traffic accidents in Nigeria. This has prompted the writing of this case which illustrated a patient with rhabdomyolysis attributable to minor blunt injuries sustained in a road traffic accident, overlooked by the patient.

Case Report

The patient is a 24-year-old male, Igbo by tribe,...

Source Citation

Source Citation   

Gale Document Number: GALE|A623903191