Aysun YAKUT, Kadir KAYATAŞ, Refik DEMİRTUNÇ, Gülbüz SEZGİN

Rabdomiyoliz ile takip edilen hastaların taburculuk kararında kreatinin kinaz düzeyinin önemi: Olgu sunumu

Araç içi trafik kazası nedeniyle acil servise getirilen 22 yaşında erkek hastanın, fizik muayenesinde; sağ frontalde ve sağ el bileğinde ekimozları olup laboratuvar incelemesinde kreatinin fosfokinaz CK seviyesi yüksekti. Hasta rabdomiyoliz ön tanısı ile iç hastalıkları servisine interne edildi. Hastada gelişebilecek hiperkalemi, metabolik asidoz ve akut tubuler nekroz gibi rabdomiyoliz komplikasyonlarının engellenmesi amacıyla %0.9`luk NaCl izotonik ile hidrate edildi. Yatışının üçüncü gününde serum CK`nın düşüş eğiliminde olduğu gözlenmesi üzerine hastaya 4000 ml/gün oral sıvı almasını ve günaşırı CK kontrolünün tarafımızca yapılması önerilerek hasta taburcu edildi. Post-travmatik rabdomiyoliz düşünülen hastalarda etkilenen kas hasarının miktarını göstermede ve takiplerde kullandığımız kreatin kinaz taburculuk planınında major belirteç olmadığı bu vakada düşünüldü. Rabdomiyoliz nedeniyle acil servise başvuran hastalarda etkilenen kas kitlesine bakılmaksızın serum CK, Cr, ve K değerleri incelenmeli, yüksek bulunan olgularda oluşabilecek komplikasyonların önlenmesi için tedaviye erken başlanmalıdır.

Anahtar Kelimeler:

rabdomiyoliz, kreatin kinaz, taburculuk, takip

The importance of creatinine kinase level in discharge decision of patients with rhabdomyolysis

A twenty-two years old men was admitted to emergency department after a motor vehicle accident, his physical examination revealed extended ecchimosis with creatinine kinase CK 37281 U/L value. The patient was refered to internal medicine clinic with the prediagnosis of rhabdomyolysis. In order to prevent rhabdomyolysis complications such as hyperkalemia, metabolic acidosis and acute tubular necrosis, hydration with 0.9% NaCI solution was administered. Serum CK was 6479 U/L at third day. Since CK was observed in the decreasing trend, the patient was recommended to drink liquids about 4000 ml/day and to check CK level every other day. In patients with possible rhabdomylolisis, CK, creatinine and K levels should be determined regardless of the muscular destruction extent and, in case of high levels, taking prompt measures to prevent complications seems wise.

Keywords:

rhabdomyolizis, creatine kinase, prosecution,

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Grossman RA, Hamilton RW, Morse BM, Penn SP, Goldberg M: Non-traumatic rhabdom- yolysis and acute renal failure. N Engl J Med 1974;291:807-811.
Donmez O, Meral A, Yavuz M, Durmaz O: Crush Syndrome of children in the Marmara earthqu- ake, Turkey. Pediatr Int. 2001; 43:678-682.
Bywaters EG, Beall D: Crush injuries with im- pairment of renal function. BMJ 1941; 1: 427.
Knochel JP: Rhabdomyolysis and myoglobinu- ria. Semin Nephrol 1981; 1: 75-86.
Knochel JP: Rhabdomyolysis and acute renal failure. Current Therapy in Neprology and Hy- pertension 4. Baskı, edi: Glassock RJ, Mosby, St. Louis, 1998, 262-265.
Oda J, Tanaka H, Yoshioka T, Iwai A, Yamamura H, Ishikawa K, Matsuoka T, Kuwagata Y, Hirai- de A, Shimazu T, Sugimoto H. Analysis of 372 patients with crush syndrome caused by the Hanshin-Awaji earthquake. J Trauma 1997; 42: 470-476.
T.C. Başbakanalık Kriz Yönetim Merkezi. Dep- remler 1999. Başbakanlık Basımevi, Ankara, 2000, s:3-15.
Roces MC, White ME, Dayrit MM, Durkin ME. Risk factors for injuries due to the 1990 eart- hquake in Luzan, Philippines. WHO Bulletin QMS. 1992; 70:509-514.
MacLean JG, Barret DS Rhabdomyolysis: a neg- lected priority in the early management of seve- re limb trauma. Injury 1993; 24: 205-207.
Slater MS, Mullins RJ. Rhabdomyolysis and myoglobinuric renal failure in trauma and sur- gical patints: A review. J Am Coll Surg 1998; 186:693-716.
Michaelson M. Crush injury and crush syndro- me. World J Surg 1992; 16:899-903.
Abbasi ZA, Hoffman A, Better OS. Acute renal failure complicating muscle crush injury. Semin Nephrol 1998; 18: 585-565.
Szewczyk D, Ovadia P, Abdullah F, Rabinovici R. Pressure-induced rhabdomyolysis and acute re- nal failure. J Trauma 1998; 44: 384-388.
Poels PJE, Gabreels FJM: Rhabdomyolysis: a re- view of literature. Clin neurol Neurosurg 1993; 95: 175-192.
Odeh M. The role of reperfusion-induced injury in the pathogenesis of the crush syndrome. N Eng J Med 1991; 324: 1417-1422.
Holt S, Moore K. Pathogenesis of renal failure in rhabdomyolysis: The role of miyoglobin. Exp Nephrol 2000; 8:72-76.
Visweswaran P, Guntupalli J. Rhabdomyolysis. Crit Care Clin 1999; 15: 415-428.
Better OS, Rubinstein I, Winaver JM, Knochel JP. Mannitol therapy revisited (1940-1997). Kidney Int 1997; 52:886-894.
Knochel JP. Rabdomyolysis and acute renal fai- lere. Current Therapy in Nephrology and Hyper- tension. 4th edition. Editor: Glassock RJ, Mos- by, St. Louis, 1998, s:262-265.
Honda N:Acute renal failure and rhabdomyoly- sis. Kidney Int 1983;23:888-898.
Slater MS, Mullins RJ: Rhabdomyolysis and myoglobinuricrenal failure in trauma and sur- gical patients:A review. J Am Coll Surg 1998; 186: 693-716.
Gabow PA, Kaehny WD, Kelleher SP:The spe- ctrum of rhabdomyolysis. Medicine 1982; 61:141-152.
Crush (ezilme) Sendromu ve Marmara Depre- minden Çıkarılan Dersler Sever MŞ, sf 17, 58, 38.
Vanholder R, Sever MS, Erek E, Lameire N. Acute renal failure related to crush syndrome:- Towards an era of seismo-nephrology? Nephrol Dial Transplant 2000; 15: 517-521.
Boles JM, Dutel JL, Briere J, Mialon P, Robasc- kiewicz M, Garre M, Briere J. Acute ranal failu- re caused by extreme hyperphospatemia after chemotherapy of an acute lymphoblastic leuke- mia. Cancer 1984; 53: 2425-2429.
Spinrad S, Grosskopf Y, Blum I, Sztern M, Graff E. Treating constipation with phosphate ene- ma: an unnecessary risk. Isr J Med Sci 1989;25: 237-328.
Better OS, Abassi Z, Rubinstein I, Marom S, Winawer Y, Silberman M. The mechanism of muscle injury in the crush syndrome: ischemic versus pressure-strech myopathy. Miner Elect- rolyte Metab 1990; 16:181-184.
Noji EK. Acute renal failure in natural disasters. Ren Fail 1992;14: 245-249.
Rose BD. Clinical Physiology of Acid-Base and Electrolyte Disorders. Me Graw-Hill Inc., New York, 2001.