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The inclusion of MDMA/ecstasy as a chemical cause of rhabdomyolysis seems a bit misleading, as I am sure there are hundreds of other stimulant-type drugs that could theoretically cause the condition, but it doesn't seem to be supported by any cited references. I'd like to see that phrase either removed or supported with a scholarly citation. -- Kat.reinhart 00:56, 24 April 2006 (UTC)
Nescio, you added some references but it is unclear which statement in the article they support (e.g. the study that compares CK levels).
JFW |
T@lk
23:44, 1 October 2005 (UTC)
Arcadian observed that there is no ICD-10 code for rhabdomyolysis. Various articles found through Google suggest that it should be T79.6 for traumatic and M68.2 ("specified muscle conditions") for non-traumatic. JFW | T@lk 22:22, 8 November 2005 (UTC)
i was interested in this topic sicne i have had it recently but i saw that this is almost the same inforation that is on a real phabdomyolysis site on the internet wrote by medical people and its not verry hepful.
thank, Wiki brah 19:20, 23 December 2005 (UTC)
This is without a doubt one of the worst written pages I have ever read. There is no consistent line of presentation from beginning to conclusion. The information is disassociative and scatter and individual contributions many time attached out of location. You're not trying to prove how smart you all are but explain an important topic to the non-cognitive to assist them in assessing someone's condition. For god's sake get it right or dump the entire page. Confused619 ( talk) 16:24, 14 February 2011 (UTC)
There is no evidence (cited or otherwise) that MDMA is a chemical cause of muscle breakdown. It is possible that (indirectly) induced hyperthermia could lead to physical muscle breakdown, but not chemical.
MDMA can cause neuroleptic malignant syndrome, in which marked rhabdomyolysis is well recognised. JFW | T@lk 21:43, 21 March 2007 (UTC)
While MDMA can be linked as a cause, I believe that a notice stating that it is much more frequent if the user is suffering from hyperpyrexia, muscle rigidity, or hyper-reflexia, as stated in http://bja.oxfordjournals.org/cgi/content/full/96/6/678#SEC4 (cited on the main page as 14). In a regular person not suffering from any of those, the risk of Rhabdomyolysis is much lower. 207.35.14.167 ( talk) 08:31, 8 February 2008 (UTC)
The LSD claim seems even more suspect. The source mentions only increased ATP demand and its source doesn't mention LSD at all, as it's a study pertaining specifically to phencyclidine. —Preceding unsigned comment added by 99.20.209.149 ( talk) 07:09, 24 April 2011 (UTC)
Perhaps an additional statement regarding the use of tasers and stun guns should be added as a cause of Rhabdomyolysis. I see that "Electric Current" is included, but as a nurse, I have treated many psychiatric patients who were tasered by the police and who became ill with Rhabdomyolysis as a result - some seriously, requiring a stay in ICU before the primary, psychiatric condition could be treated.—Preceding unsigned comment added by 4.246.224.248 ( talk • contribs)
I was admiited to [NAME OF INSTITUTION REMOVED] on January 19th, 2007, after collapsing with Legionaires Disease and renal failure. Unfortunately, I am lactose-intolerant, but was force-fed a normal diet for the four weeks I was in a coma. I lost over 40kgs. On my discharge summary, it stated I was diagnosd with Rdabdomyolysis on admission. My contention is the lactose poisoning may have caused this, given my reactins were phusically similar to previous attacks of lactose poisoning. The discharge statement is false also because while I was losing weight and maintaining zero kidney function, the hospital staff informed a nurse from another department that there was no clue as to the cause of my muscle breakdown: which ocurred after my admission. Reference discharge summary [NAME OF INSTITUTION REMOVED] 21/03/2007; patient MRN [REMOVED] -- Alarchdu ( talk) 12:55, 27 November 2007 (UTC)
When I typed my original comments (as alarchdu), I was still learning to type, hence the errors. I have come back to this three years later, by happenstance. It seems that time has not removed the blinkers from everybody. After three years of further medical literature research and innumerable discussions, it seems that my original contention is still valid. I can imagine why no reliable lactose intolerance experiments have been done. It would take a very brave (or very masochistic) lactose-intolerant person to willingly ingest about the 15 grams of lactose sugar in one hour needed to develop observable lactose poisoning symptoms. Thus it remains in the realm of theoretical medicine.
After about two hours these symptoms include feverish temperatures and copious sweating, dangerous hypertension, uncontrollable vomiting and dry retching, and debilitating diarrhoea. Smaller doses of lactose ingestion cause only antisocial gaseous effusions. Contrary to the comments made about my original statements, I never said that lactose intolerance was a cause of rhabdomyolysis. Rather it is the ingestion of lactose by the lactose intolerant, already suffering from a severe infection, that can cause and maintain rhabdomyolysis even when the original infection has been cured, since lactose ingestion will cause the mimicing of all the symptoms of an infection in the lactose intolerant. Neville J. Angove ( talk) 11:38, 14 December 2010 (UTC)
I'd be happy to help... but I don't know much about this topic or what the article's needs are. Can someone post a task list here, or a vision of what the article might look like at the end (beyond than "longer")? WhatamIdoing ( talk) 22:55, 31 December 2007 (UTC)
We've made some progress. What's next? Is there a particular section that you'd like to have sourced or expanded? Should we re-invite WPMED folks to come take a look before the topic changes on Monday? WhatamIdoing ( talk) 22:45, 13 January 2008 (UTC)
The following sources were mentioned in the article:
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link)I have moved them here now, but they might be useful as sources once they can be footnoted. The personal webpage is interesting, but primarily as a source for further references. JFW | T@lk 14:54, 1 January 2008 (UTC)
This article could really use an image to help the reader relate to what is being said. If anyone has an image that could be applied, please upload it to the Wikimedia Commons so we can place it on the article. Thanks. Cyclonenim ( talk) 17:24, 2 January 2008 (UTC)
I would not immediately object to an image of a collapsed building, as crush injury was the first well-recognised cause for rhabdomyolysis. But real illustrative images would be of the myoglobin molecule, the microscopic pathology of acute tubular necrosis, and perhaps a haemofiltration machine. JFW | T@lk 11:15, 6 January 2008 (UTC)
At the moment we are citing some very basic science papers and a review from a Saudi low-impact journal. I don't think these are tremendously useful sources, and I think we should strive to build the article around comprehensive reviews in high-impact journals.
I've found the following:
I will read the Crit Care paper and possibly the JASN one to see which one would be most useful - probably both. JFW | T@lk 11:15, 6 January 2008 (UTC)
I don't think we can support statins as an agreed cause any longer (except perhaps in the specific named case, which I haven't looked up):
A matched-control observational study at Kaiser Permanente indicates that statin initiation did not appear to be associated with an increased risk for rhabdomyolysis, with all patients having a rate of rhabdomyolysis of about 0.2 per 1000 person-years. [1] A review of randomized clinical trials agrees that there is no association. [2]
Should we delete statins from the list? Does anyone know more about this than I do? (The first ref here might be useful for a new epidemiology section.) WhatamIdoing ( talk) 21:57, 9 January 2008 (UTC)
Since the sources I found are very new, I'm not at all surprised that their conclusions are not cited in older works. I'd be fine with listing all the sources, but right now the only source listed in the article is the Crit Care review, and it provides no actual data that statins (except cerivastatin) are associated with an increased rate of rhabdomyolysis. What's the PMID for the study you want to cite? WhatamIdoing ( talk) 20:45, 10 January 2008 (UTC)
The article made it out as if bicarbonate infusion is the standard of care, and supports this largely with non-clinical research. In fact, the CritCare2005 paper makes it clear that there is not a lot of evidence that bicarbonate makes any difference on outcomes. I am moving the content here for consideration:
I also feel that we should not be using case reports where better studies (preferably reviews or trials) are available. JFW | T@lk 07:25, 10 January 2008 (UTC)
About the calcium-phosphate-Vitamin D issue: Are you aware of any reports of exogenous Vitamin D supplementation? It seems (from the theoretical perspective) that it might interrupt that vicious cycle. WhatamIdoing ( talk) 02:09, 27 January 2008 (UTC)
PMID 2279155 is a fascinating historical account on how the doctors at the RPMS/Hammersmith discovered the mechanism of rhabdomyolysis. It turns out that many of their discoveries had already been made in Messina and during WWI, and that they rediscovered much of this; this was however without the benefit of their library facilities, because London was being bombed etc. When rereading the "pathophysiology" paragraph I cannot help but notice how much these guys discovered and how little has changed since then.
On an unrelated note, Bywaters makes the astonishing mention of Ludwig Wittgenstein assisting the team in Newcastle, specifically his skill in preparing lungs from autopsied patients for inspection! JFW | T@lk 21:58, 2 February 2008 (UTC)
General comments
Specific comments
I'll put this on hold for now, but its almost there. Tim Vickers ( talk) 02:44, 24 February 2008 (UTC)
Looks to me like Ca2+ activates a phospholipase that damages the mitochondrion, which will cause ROS production. I've changed the article to say this for now but if the more specific refs contradict this feel free to change it back. This seemed off to me since calcium isn't a redox-active transition metal, so can't produce ROS directly. Anyway, looks good now, I'll list this as a GA. Congratulations everybody! Tim Vickers ( talk) 17:03, 24 February 2008 (UTC)
Tim's GA review has prompted me to give the article another look. I have changed some references to higher-quality sources, tried to eliminate more technospeak and parentheses, and improved the "list of causes" by splitting the list of pharmacological causes.
Issues that remain as far as I am concerned:
Much of this is not crucial for GA, but would enhance the article and make it more likely to become a FA. JFW | T@lk 12:25, 24 February 2008 (UTC)
I trawled through today's changes, and I'm not sure about the removal of this sentence: "High potassium levels occur in traumatic rhabdomyolysis but not necessarily in other forms." Do we have a source to support this trauma-but-not-others claim? WhatamIdoing ( talk) 19:02, 1 March 2008 (UTC)
Yet this is what the sources mention. I would not remove content that has a good reference behind it unless you can provide good evidence that (1) the source is wrong, (2) the source has been superseded, (3) there are exceptions to a generalisation made by the source etc etc. JFW | T@lk 07:14, 2 March 2008 (UTC)
I learned about rhabdomyolysis from this article on the Crossfit phenomenon. This condition seems to be a big issue in the Crossfit community. They even have a mascot called Uncle Rhabdo — a vomiting clown.
The article needs to say more about exercise and rhabdomyolysis, since that seems to be the context in which most people will encounter it.-- Isaac R ( talk) 17:35, 23 March 2008 (UTC)
J. Campbell's notes in the [2] thread suggested the Rhabdomyolysis link to me. This note is more or less analogous to the Crossfit note above, but substitute "Screaming Barfies" for "Uncle Rhabdo". In both cases, we have a community coming up with a black comedy term to describe a very common but extraordinarily painful shared experience. The barfies are a very common occurrence in ice climbing, and occasionally happen in other forms of cold weather climbing (I got them yesterday morning on my right side after using mechanical ascenders, right hand high, on a long fixed line). I've never heard of a case where symptoms did not go away after a few minutes (it's a bit like eating too much wasabi, only it lasts longer and is a whole lot less fun).
The same arguments against including Crossfit in this page will of course apply to ice climbing and the dreaded Screaming Barfies. However, I strongly suspect that J. Campbell is correct in his guess that the barfies are a mild form of rhabdo. If he is, then the assertion that rhabdo is a rare occurrence is then incorrect. --Eric H. 66.193.41.200 ( talk) 21:03, 5 December 2008 (UTC)
Should Myoglobinemia redirect here? WhatamIdoing ( talk) 21:59, 27 June 2008 (UTC)
I would like to note that I am very greatfull for this information. My son who is 21 suffered from Rhabdomyolysis not from exercise or under a heap of rubble, but from simply falling asleep on his arm while helping his uncle work on his rental property out of town. The property didn't have any furniture so they slept on the floor. My son woke up not being able to move his arm and had to be rushed to the hospital. 3 surgeries later and dialysis he is home trying to figure out how to lead a productive life without the use of his left arm. This happens more than one might think and under some bizarre circumstances. ACS 76.122.144.187 ( talk) 01:27, 14 July 2008 (UTC)
Two users recently added a reference to PMID 10592946. This is a single case report on rhabdomyolysis after drinking 15 litres of oolong tea; even the abstract suggests that the link between its caffeine content and rhabdomyolysis may have been confounded by the conincidental hyponatraemia. I cannot imagine this is sufficient, and the major reviews (Crit Care and JASN) both ignore the report. JFW | T@lk 07:27, 4 August 2008 (UTC)
PMID 16267412 has a large case series (475) of rhabdomyolysis. Some potentially interesting data, but I can't see whether this has been quoted in the reviews or not. JFW | T@lk 21:32, 17 August 2008 (UTC)
This article needs to reference the article on "tying up," otherwise known as Equine Exertional Rhabdomyolysis. Veterinary medicine is a lot more familiar with the condition. Godofredo29 ( talk) 19:30, 15 November 2008 (UTC)
An anonymous contributor added that Accutane, a retinoic acid derivative used in acne, could cause rhabdomyolysis. A quick Pubmed search here shows that there are three case reports on the subject, and a further small study that shows that elevated CK in people on Accutane is a benign phenomenon. Given that we have no secondary sources discussing this, I don't think there is much point in mentioning this in the article.
There are numerous case reports on "some substance" causing rhabdomyolysis. This is easy research (muscle pain + high CK + patient taking odd drug + patient gets better when drug gets stopped), and often there are significant problems with the quality of the research. We must stick with our main sources when listing chemical causes of rhabdomyolysis. JFW | T@lk 20:28, 31 December 2008 (UTC)
It was suggested in the body of the text that liver failure is associated with rhabdomyolysis in around 25% of cases. This is supported by an article in 'critical care'. However, if you look at their source for that figure, it is a small study of patients with non-traumatic rhabdomyolysis (PMID: 2343880). Their definition of hepatic impairment included patients with only a high AST, ALT and LDH, all of which are released from damaged muscles and are not specific for liver disease in this condition. This fact often leads to rhabdomyolysis being confused with acute liver failure if a CK test is not performed particularly in non-traumatic cases where there may be only non-specific symptoms. I changed the text to reflect this fact. gearoidmm ( talk) 22:52, 5 January 2009 (UTC)
Will need to pull this and update the article if needed: http://content.nejm.org/cgi/content/short/361/1/62 JFW | T@lk 10:27, 2 July 2009 (UTC)
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help)That section probably needs to be adjusted a bit. A search on exercise induced rhabdomyolysis netted this article (annoying ads, but seemed to link to good sources) that exercise induced rhabdomyolysis may be more common that the article gives it credit for. In addition the rest of the article is similarly focused on trauma causes and should probably be adjusted in light of WP:NPOV#UNDUE. In this case it's not really about the prevalence of viewpoints, but about the prevalence of the causes of the condition. - Taxman Talk 16:22, 14 October 2009 (UTC)
I've re-read the article and can't help notice there is very little discussion of the consequence of rhabdomyolysis on the muscle tissue itself. As noted above, these can be severe, yet there is not even a suggestion that Rhabdomyolysis can lead to complete loss of muscle function! Circéus ( talk) 13:24, 6 April 2010 (UTC)
Les formes modérées, paucisymptomatiques de rhabdomoyolyse guériront spontanément en l'absence de mesures thérapeutiques agressives
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We could use an image of urine from someone with rhabdomyolysis. Will take a photo next time I have a case unless someone already has one. Doc James ( talk · contribs · email) 08:40, 4 May 2010 (UTC)
The introduction as it is now reads: "rhabdomyolysis is the breakdown of muscle tissue due to injury." It is true that one cause of rhabdomyolysis is caused by injury, but that is not the only cause. There are many others as well including over-exertion, suddenly and erratic increase in strenous exercise, and even heat stroke. A person who has never encountered this condition before may go to the Wikipedia site and read the first sentence and assume they don't have it because they were not injured. In fact many common cases of rhabdomyolysis are not caused by injury. A more accurate introduction would focus on the condition itself which is simply the breaking down of skeletal muscle tissue and leakage of the contents into the bloodstream.
Again, the introduction needs more editing. The second paragraph states "The disease and its mechanisms were first elucidated in the Blitz of London in 1941.[3]" This statement is misleading. The actual article reads: "In modern English medical literature, the authors of the first detailed report of ARF related to the crush syndrome were Bywaters and Beall. They observed the condition in four victims of the bombing of London during the Battle of Britain in 1940 (7)." The article says "the first detailed report of ARF" - acute renal failure. Acute renal failure is a severe complication of rhabdomyolysis. So a detailed report of people who suffered ARF in the London bombing of 1940 becomes "the first elucidation of the disease and its mechanisms"? I don't think so. —Preceding unsigned comment added by 131.96.91.71 ( talk) 13:14, 27 July 2010 (UTC)
This is a job I've left for much too long, but I've decided to review the content of the article with the help of Bosch. The source has been around for a while, but I've never quite taken the time to implement its main points fully.
I have removed doi:10.1016/S0140-6736(01)05950-5 as a source. It is cited as evidence that tasers cause rhabdomyolysis, but this is an aside in this commentary and speaks only of "mild rhabdomyolysis". Some other unreliable sources will be removed also. JFW | T@lk 21:51, 16 February 2011 (UTC)
Schedule for updating:
This should one day become an FA candidate, but let's bring it up to date first. JFW | T@lk 11:01, 21 February 2011 (UTC)
I had a look through the Cochrane database of systematic reviews ( protocol for CVVH review). There are currently no reviews available, just as the only guideline available for rhabdomyolysis seems to be from Finland. That leaves the recent reviews, most of which we seem to have covered now. JFW | T@lk 17:47, 15 April 2011 (UTC)
Hey Doc:
I went through Rhabdomyolysis rather carefully, and compiled the following list of ideas, suggestions, nitpicks, etc. - many of which may be wrong and/or cheesy, etc. In any case, I thought I'd just go ahead and throw them your way, to do with as you see fit. These aside, I must say HELLOVA GREAT JOB - EXCELLENT ARTICLE!
With very best regards, I remain
Your fan: Cliff L. Knickerbocker, MS ( talk) 17:57, 17 April 2011 (UTC)
REVIEW [sic] OF RHABDOMYOLYSIS
Respectfully submitted by: Cliff Knickerbocker, M.S. 17 April 2011
LEDE
SIGNS AND SYMPTOMS
TABLE OF CAUSES
PATHOPHYSIOLOGY
GENERAL INVESTIGATIONS
COMPLICATIONS
UNDERLYING DISORDERS
Acute Renal Failure Subsection
EPIDEMIOLOGY
I've done a PubMed search with rhabdomyolysis as a "major" topic and restricted to reviews. Naturally, a lot of reviews are disguised case reports. A few of the others (going back to 2005) are:
The peer review is still open, but it is probably time we get this towards FAC when that closes. JFW | T@lk 11:09, 3 May 2011 (UTC)
My attention was directed here by the FA nom; I find FA reviews annoyingly cluttered so I will discuss my issues here, if that's okay. Here is my first issue: in the Mechanism section, there is a line saying "those cells that survive react by pumping sodium ions out of the cells in exchange for calcium ions (through the sodium-calcium exchanger)". Is this correct? Normally the sodium-calcium exchanger pumps calcium out driven by the gradient of sodium flowing in. Looie496 ( talk) 17:30, 23 May 2011 (UTC)
The Bible section contains "traveling" (US) and "travelled" (UK). Aa77zz ( talk) 20:14, 23 May 2011 (UTC)
Should the 2010 Haiti earthquake be mentioned in this article? Possible sources include [4] and [5], but the sources are thin, probably because it was so WP:RECENT (relative to the academic publishing schedule). What do you think? WhatamIdoing ( talk) 00:27, 24 May 2011 (UTC)
On FAC, both Axl ( talk · contribs) and Casliber ( talk · contribs) have now stated that the article does not meet WP:WIAFA without a reshuffle of the "causes" section. I have taken this discussion to various places to get a better idea of what people regard as a well-classified list of information (e.g. WT:MED, WT:MEDMOS). The responses have been limited. I am being guided by Axl's suggestion that we take the framework of a good secondary source. He recommended the Oxford Textbook of Medicine and was good enough to provide a table from that source ( diff) although I am unsure which edition it was taken from. I have accessed the most recent edition ( ISBN 0199204853, 5th edition), which has a similar but different table in chapter 21.5 (box 21.5.4). It uses a grouping that seems to roughly follow the surgical sieve. I am veering towards using the classification of either NEJM (but lifting out the genetic causes for separate treatment) or Warren.
Warren uses (table 1):
I do not plan to mention the elaborate subclassification on myocyte level that Warren uses, mainly because it is highly technical and secondly because most of it seems to be based on a degree of speculation. JFW | T@lk 09:13, 5 June 2011 (UTC)
Due to space constraints the article does not contain a more detailed desciption of the historical and toxicological context of coturnism (rhabdomyolysis after eating quail). I have just discovered doi:10.1001/jama.1970.03170070056017 (JAMA 1970) which traces most of the reports back to the 1940s in Algeria.
Sheredot ( talk · contribs) added a reference to a report that suggested that Stachys annua was the toxic plant involved ( doi:10.1080/08873638709478507) rather than hemlock. This is not consistent with other reports ( doi:10.1503/cmaj.1031256 - CMAJ 2004) that implicates hemlock and Galeopsis laudanum and doi:10.1021/jf902764n (J Agric Food Chem) that exonerates Slachys and Galeopsis.
It would be helpful to have a secondary source available that can support any further additions to the article (see WP:MEDRS). JFW | T@lk 13:31, 24 June 2011 (UTC)
The important point is that the hemlock myth, which has been around for 2,000 years, is known to be false. It is a fundamental point that whatever the poison, or plant source, the quail eat it without ill effect. Any plant that poisons quail must be excluded. This must also throw doubt on using rats as a useful experimental animal. How does one know whether they are like humans or like (migrating) quail. Do quail, as I suspect, have a different metabolism when migrating? Sheredot ( talk) 09:13, 26 June 2011 (UTC)
These subsequent reports merely assume the hemlock cause they provide no evidence. Problems with hemlock poisoning come in in four areas (1) Hemlock seed kills quail, (2) Hemlock produces a sharp appetite depressant effect in quail, (3) Quail are toxic when hemlock seed is not available for consumption, and (4) Cotumix cannot accumulate toxic elements in hemlock seed. see Toxic quail: A cultural‐ecological investigation of coturnism.Bruce W. Kennedy & Louis Evan Grivetti Ecology of Food and Nutrition Volume 9, Issue 1, January 1980, pages 15-41 Ancient Greeks Aristotle, Galen etc. are c.2000 yrs ago Sheredot ( talk) 10:29, 29 June 2011 (UTC)
This is a separate article. It also refers to the condition as "Bywater's syndrome". This article ought to be either incorporated, or linked in some way. Amandajm ( talk) 13:09, 20 September 2011 (UTC)
Checking up on the template addition by a previous editor and adding a discussion area. Separate from the other conversation above about coturnism as a topic in this article, the Contradict-other template appears valid as there is a WP issue with two contradictory articles - coturnism directly contradicts the information given here. Thanks for helping! Universaladdress ( talk) 03:30, 20 April 2012 (UTC)
doi:10.1097/CND.0b013e31822721ca is a review specifically about exertional RM. The abstract and references look good, but I need to get hold of the fulltext before deciding to include it. JFW | T@lk 01:41, 7 October 2012 (UTC)
Is there a cure out for this disease? My fiancee's 7 yr old brother may have this disease. Is there anything out today that will reverse the affects of this? Neurontin/gabapentin maybe? — Preceding unsigned comment added by Sethwede1230( talk • contribs) 21:23, 13 December 2012 (UTC)
We cannot offer medical advice. Please see
the medical disclaimer, and contact an appropriate medical professional. --
Scray (
talk)
02:33, 14 December 2012 (UTC)
just added some more pictures and strategies for prevention.
Just want to explain why there was an addition to the treatment section. It is part of a project for a college class. Just a heads up! — Preceding unsigned comment added by MikalaB ( talk • contribs) 23:25, 21 May 2013 (UTC)
We needed to add our own research to the page for a college class assignment.
doi:10.1001/jamainternmed.2013.9774 is a nice paper using data of 1000s of patients to derive and validate a risk score for RRT or death in those with CK>5000 within 3 days of admission. I'm pretty sure that it will very soon be reflected in secondary sources. The risk score is based on age, sex (prognosis worse in females), the initial creatinine, calcium, CK (>40,000 is worse), underlying cause (prognosis better in seizures, syncope, exercise, statins, or myositis), and initial phosphate and bicarbonate.
I won't currently reference the article, but will monitor the secondary sources for mention. JFW | T@lk 11:08, 3 September 2013 (UTC)
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![]() | This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
Archive 1 | Archive 2 |
The inclusion of MDMA/ecstasy as a chemical cause of rhabdomyolysis seems a bit misleading, as I am sure there are hundreds of other stimulant-type drugs that could theoretically cause the condition, but it doesn't seem to be supported by any cited references. I'd like to see that phrase either removed or supported with a scholarly citation. -- Kat.reinhart 00:56, 24 April 2006 (UTC)
Nescio, you added some references but it is unclear which statement in the article they support (e.g. the study that compares CK levels).
JFW |
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23:44, 1 October 2005 (UTC)
Arcadian observed that there is no ICD-10 code for rhabdomyolysis. Various articles found through Google suggest that it should be T79.6 for traumatic and M68.2 ("specified muscle conditions") for non-traumatic. JFW | T@lk 22:22, 8 November 2005 (UTC)
i was interested in this topic sicne i have had it recently but i saw that this is almost the same inforation that is on a real phabdomyolysis site on the internet wrote by medical people and its not verry hepful.
thank, Wiki brah 19:20, 23 December 2005 (UTC)
This is without a doubt one of the worst written pages I have ever read. There is no consistent line of presentation from beginning to conclusion. The information is disassociative and scatter and individual contributions many time attached out of location. You're not trying to prove how smart you all are but explain an important topic to the non-cognitive to assist them in assessing someone's condition. For god's sake get it right or dump the entire page. Confused619 ( talk) 16:24, 14 February 2011 (UTC)
There is no evidence (cited or otherwise) that MDMA is a chemical cause of muscle breakdown. It is possible that (indirectly) induced hyperthermia could lead to physical muscle breakdown, but not chemical.
MDMA can cause neuroleptic malignant syndrome, in which marked rhabdomyolysis is well recognised. JFW | T@lk 21:43, 21 March 2007 (UTC)
While MDMA can be linked as a cause, I believe that a notice stating that it is much more frequent if the user is suffering from hyperpyrexia, muscle rigidity, or hyper-reflexia, as stated in http://bja.oxfordjournals.org/cgi/content/full/96/6/678#SEC4 (cited on the main page as 14). In a regular person not suffering from any of those, the risk of Rhabdomyolysis is much lower. 207.35.14.167 ( talk) 08:31, 8 February 2008 (UTC)
The LSD claim seems even more suspect. The source mentions only increased ATP demand and its source doesn't mention LSD at all, as it's a study pertaining specifically to phencyclidine. —Preceding unsigned comment added by 99.20.209.149 ( talk) 07:09, 24 April 2011 (UTC)
Perhaps an additional statement regarding the use of tasers and stun guns should be added as a cause of Rhabdomyolysis. I see that "Electric Current" is included, but as a nurse, I have treated many psychiatric patients who were tasered by the police and who became ill with Rhabdomyolysis as a result - some seriously, requiring a stay in ICU before the primary, psychiatric condition could be treated.—Preceding unsigned comment added by 4.246.224.248 ( talk • contribs)
I was admiited to [NAME OF INSTITUTION REMOVED] on January 19th, 2007, after collapsing with Legionaires Disease and renal failure. Unfortunately, I am lactose-intolerant, but was force-fed a normal diet for the four weeks I was in a coma. I lost over 40kgs. On my discharge summary, it stated I was diagnosd with Rdabdomyolysis on admission. My contention is the lactose poisoning may have caused this, given my reactins were phusically similar to previous attacks of lactose poisoning. The discharge statement is false also because while I was losing weight and maintaining zero kidney function, the hospital staff informed a nurse from another department that there was no clue as to the cause of my muscle breakdown: which ocurred after my admission. Reference discharge summary [NAME OF INSTITUTION REMOVED] 21/03/2007; patient MRN [REMOVED] -- Alarchdu ( talk) 12:55, 27 November 2007 (UTC)
When I typed my original comments (as alarchdu), I was still learning to type, hence the errors. I have come back to this three years later, by happenstance. It seems that time has not removed the blinkers from everybody. After three years of further medical literature research and innumerable discussions, it seems that my original contention is still valid. I can imagine why no reliable lactose intolerance experiments have been done. It would take a very brave (or very masochistic) lactose-intolerant person to willingly ingest about the 15 grams of lactose sugar in one hour needed to develop observable lactose poisoning symptoms. Thus it remains in the realm of theoretical medicine.
After about two hours these symptoms include feverish temperatures and copious sweating, dangerous hypertension, uncontrollable vomiting and dry retching, and debilitating diarrhoea. Smaller doses of lactose ingestion cause only antisocial gaseous effusions. Contrary to the comments made about my original statements, I never said that lactose intolerance was a cause of rhabdomyolysis. Rather it is the ingestion of lactose by the lactose intolerant, already suffering from a severe infection, that can cause and maintain rhabdomyolysis even when the original infection has been cured, since lactose ingestion will cause the mimicing of all the symptoms of an infection in the lactose intolerant. Neville J. Angove ( talk) 11:38, 14 December 2010 (UTC)
I'd be happy to help... but I don't know much about this topic or what the article's needs are. Can someone post a task list here, or a vision of what the article might look like at the end (beyond than "longer")? WhatamIdoing ( talk) 22:55, 31 December 2007 (UTC)
We've made some progress. What's next? Is there a particular section that you'd like to have sourced or expanded? Should we re-invite WPMED folks to come take a look before the topic changes on Monday? WhatamIdoing ( talk) 22:45, 13 January 2008 (UTC)
The following sources were mentioned in the article:
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link)I have moved them here now, but they might be useful as sources once they can be footnoted. The personal webpage is interesting, but primarily as a source for further references. JFW | T@lk 14:54, 1 January 2008 (UTC)
This article could really use an image to help the reader relate to what is being said. If anyone has an image that could be applied, please upload it to the Wikimedia Commons so we can place it on the article. Thanks. Cyclonenim ( talk) 17:24, 2 January 2008 (UTC)
I would not immediately object to an image of a collapsed building, as crush injury was the first well-recognised cause for rhabdomyolysis. But real illustrative images would be of the myoglobin molecule, the microscopic pathology of acute tubular necrosis, and perhaps a haemofiltration machine. JFW | T@lk 11:15, 6 January 2008 (UTC)
At the moment we are citing some very basic science papers and a review from a Saudi low-impact journal. I don't think these are tremendously useful sources, and I think we should strive to build the article around comprehensive reviews in high-impact journals.
I've found the following:
I will read the Crit Care paper and possibly the JASN one to see which one would be most useful - probably both. JFW | T@lk 11:15, 6 January 2008 (UTC)
I don't think we can support statins as an agreed cause any longer (except perhaps in the specific named case, which I haven't looked up):
A matched-control observational study at Kaiser Permanente indicates that statin initiation did not appear to be associated with an increased risk for rhabdomyolysis, with all patients having a rate of rhabdomyolysis of about 0.2 per 1000 person-years. [1] A review of randomized clinical trials agrees that there is no association. [2]
Should we delete statins from the list? Does anyone know more about this than I do? (The first ref here might be useful for a new epidemiology section.) WhatamIdoing ( talk) 21:57, 9 January 2008 (UTC)
Since the sources I found are very new, I'm not at all surprised that their conclusions are not cited in older works. I'd be fine with listing all the sources, but right now the only source listed in the article is the Crit Care review, and it provides no actual data that statins (except cerivastatin) are associated with an increased rate of rhabdomyolysis. What's the PMID for the study you want to cite? WhatamIdoing ( talk) 20:45, 10 January 2008 (UTC)
The article made it out as if bicarbonate infusion is the standard of care, and supports this largely with non-clinical research. In fact, the CritCare2005 paper makes it clear that there is not a lot of evidence that bicarbonate makes any difference on outcomes. I am moving the content here for consideration:
I also feel that we should not be using case reports where better studies (preferably reviews or trials) are available. JFW | T@lk 07:25, 10 January 2008 (UTC)
About the calcium-phosphate-Vitamin D issue: Are you aware of any reports of exogenous Vitamin D supplementation? It seems (from the theoretical perspective) that it might interrupt that vicious cycle. WhatamIdoing ( talk) 02:09, 27 January 2008 (UTC)
PMID 2279155 is a fascinating historical account on how the doctors at the RPMS/Hammersmith discovered the mechanism of rhabdomyolysis. It turns out that many of their discoveries had already been made in Messina and during WWI, and that they rediscovered much of this; this was however without the benefit of their library facilities, because London was being bombed etc. When rereading the "pathophysiology" paragraph I cannot help but notice how much these guys discovered and how little has changed since then.
On an unrelated note, Bywaters makes the astonishing mention of Ludwig Wittgenstein assisting the team in Newcastle, specifically his skill in preparing lungs from autopsied patients for inspection! JFW | T@lk 21:58, 2 February 2008 (UTC)
General comments
Specific comments
I'll put this on hold for now, but its almost there. Tim Vickers ( talk) 02:44, 24 February 2008 (UTC)
Looks to me like Ca2+ activates a phospholipase that damages the mitochondrion, which will cause ROS production. I've changed the article to say this for now but if the more specific refs contradict this feel free to change it back. This seemed off to me since calcium isn't a redox-active transition metal, so can't produce ROS directly. Anyway, looks good now, I'll list this as a GA. Congratulations everybody! Tim Vickers ( talk) 17:03, 24 February 2008 (UTC)
Tim's GA review has prompted me to give the article another look. I have changed some references to higher-quality sources, tried to eliminate more technospeak and parentheses, and improved the "list of causes" by splitting the list of pharmacological causes.
Issues that remain as far as I am concerned:
Much of this is not crucial for GA, but would enhance the article and make it more likely to become a FA. JFW | T@lk 12:25, 24 February 2008 (UTC)
I trawled through today's changes, and I'm not sure about the removal of this sentence: "High potassium levels occur in traumatic rhabdomyolysis but not necessarily in other forms." Do we have a source to support this trauma-but-not-others claim? WhatamIdoing ( talk) 19:02, 1 March 2008 (UTC)
Yet this is what the sources mention. I would not remove content that has a good reference behind it unless you can provide good evidence that (1) the source is wrong, (2) the source has been superseded, (3) there are exceptions to a generalisation made by the source etc etc. JFW | T@lk 07:14, 2 March 2008 (UTC)
I learned about rhabdomyolysis from this article on the Crossfit phenomenon. This condition seems to be a big issue in the Crossfit community. They even have a mascot called Uncle Rhabdo — a vomiting clown.
The article needs to say more about exercise and rhabdomyolysis, since that seems to be the context in which most people will encounter it.-- Isaac R ( talk) 17:35, 23 March 2008 (UTC)
J. Campbell's notes in the [2] thread suggested the Rhabdomyolysis link to me. This note is more or less analogous to the Crossfit note above, but substitute "Screaming Barfies" for "Uncle Rhabdo". In both cases, we have a community coming up with a black comedy term to describe a very common but extraordinarily painful shared experience. The barfies are a very common occurrence in ice climbing, and occasionally happen in other forms of cold weather climbing (I got them yesterday morning on my right side after using mechanical ascenders, right hand high, on a long fixed line). I've never heard of a case where symptoms did not go away after a few minutes (it's a bit like eating too much wasabi, only it lasts longer and is a whole lot less fun).
The same arguments against including Crossfit in this page will of course apply to ice climbing and the dreaded Screaming Barfies. However, I strongly suspect that J. Campbell is correct in his guess that the barfies are a mild form of rhabdo. If he is, then the assertion that rhabdo is a rare occurrence is then incorrect. --Eric H. 66.193.41.200 ( talk) 21:03, 5 December 2008 (UTC)
Should Myoglobinemia redirect here? WhatamIdoing ( talk) 21:59, 27 June 2008 (UTC)
I would like to note that I am very greatfull for this information. My son who is 21 suffered from Rhabdomyolysis not from exercise or under a heap of rubble, but from simply falling asleep on his arm while helping his uncle work on his rental property out of town. The property didn't have any furniture so they slept on the floor. My son woke up not being able to move his arm and had to be rushed to the hospital. 3 surgeries later and dialysis he is home trying to figure out how to lead a productive life without the use of his left arm. This happens more than one might think and under some bizarre circumstances. ACS 76.122.144.187 ( talk) 01:27, 14 July 2008 (UTC)
Two users recently added a reference to PMID 10592946. This is a single case report on rhabdomyolysis after drinking 15 litres of oolong tea; even the abstract suggests that the link between its caffeine content and rhabdomyolysis may have been confounded by the conincidental hyponatraemia. I cannot imagine this is sufficient, and the major reviews (Crit Care and JASN) both ignore the report. JFW | T@lk 07:27, 4 August 2008 (UTC)
PMID 16267412 has a large case series (475) of rhabdomyolysis. Some potentially interesting data, but I can't see whether this has been quoted in the reviews or not. JFW | T@lk 21:32, 17 August 2008 (UTC)
This article needs to reference the article on "tying up," otherwise known as Equine Exertional Rhabdomyolysis. Veterinary medicine is a lot more familiar with the condition. Godofredo29 ( talk) 19:30, 15 November 2008 (UTC)
An anonymous contributor added that Accutane, a retinoic acid derivative used in acne, could cause rhabdomyolysis. A quick Pubmed search here shows that there are three case reports on the subject, and a further small study that shows that elevated CK in people on Accutane is a benign phenomenon. Given that we have no secondary sources discussing this, I don't think there is much point in mentioning this in the article.
There are numerous case reports on "some substance" causing rhabdomyolysis. This is easy research (muscle pain + high CK + patient taking odd drug + patient gets better when drug gets stopped), and often there are significant problems with the quality of the research. We must stick with our main sources when listing chemical causes of rhabdomyolysis. JFW | T@lk 20:28, 31 December 2008 (UTC)
It was suggested in the body of the text that liver failure is associated with rhabdomyolysis in around 25% of cases. This is supported by an article in 'critical care'. However, if you look at their source for that figure, it is a small study of patients with non-traumatic rhabdomyolysis (PMID: 2343880). Their definition of hepatic impairment included patients with only a high AST, ALT and LDH, all of which are released from damaged muscles and are not specific for liver disease in this condition. This fact often leads to rhabdomyolysis being confused with acute liver failure if a CK test is not performed particularly in non-traumatic cases where there may be only non-specific symptoms. I changed the text to reflect this fact. gearoidmm ( talk) 22:52, 5 January 2009 (UTC)
Will need to pull this and update the article if needed: http://content.nejm.org/cgi/content/short/361/1/62 JFW | T@lk 10:27, 2 July 2009 (UTC)
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help)That section probably needs to be adjusted a bit. A search on exercise induced rhabdomyolysis netted this article (annoying ads, but seemed to link to good sources) that exercise induced rhabdomyolysis may be more common that the article gives it credit for. In addition the rest of the article is similarly focused on trauma causes and should probably be adjusted in light of WP:NPOV#UNDUE. In this case it's not really about the prevalence of viewpoints, but about the prevalence of the causes of the condition. - Taxman Talk 16:22, 14 October 2009 (UTC)
I've re-read the article and can't help notice there is very little discussion of the consequence of rhabdomyolysis on the muscle tissue itself. As noted above, these can be severe, yet there is not even a suggestion that Rhabdomyolysis can lead to complete loss of muscle function! Circéus ( talk) 13:24, 6 April 2010 (UTC)
Les formes modérées, paucisymptomatiques de rhabdomoyolyse guériront spontanément en l'absence de mesures thérapeutiques agressives
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We could use an image of urine from someone with rhabdomyolysis. Will take a photo next time I have a case unless someone already has one. Doc James ( talk · contribs · email) 08:40, 4 May 2010 (UTC)
The introduction as it is now reads: "rhabdomyolysis is the breakdown of muscle tissue due to injury." It is true that one cause of rhabdomyolysis is caused by injury, but that is not the only cause. There are many others as well including over-exertion, suddenly and erratic increase in strenous exercise, and even heat stroke. A person who has never encountered this condition before may go to the Wikipedia site and read the first sentence and assume they don't have it because they were not injured. In fact many common cases of rhabdomyolysis are not caused by injury. A more accurate introduction would focus on the condition itself which is simply the breaking down of skeletal muscle tissue and leakage of the contents into the bloodstream.
Again, the introduction needs more editing. The second paragraph states "The disease and its mechanisms were first elucidated in the Blitz of London in 1941.[3]" This statement is misleading. The actual article reads: "In modern English medical literature, the authors of the first detailed report of ARF related to the crush syndrome were Bywaters and Beall. They observed the condition in four victims of the bombing of London during the Battle of Britain in 1940 (7)." The article says "the first detailed report of ARF" - acute renal failure. Acute renal failure is a severe complication of rhabdomyolysis. So a detailed report of people who suffered ARF in the London bombing of 1940 becomes "the first elucidation of the disease and its mechanisms"? I don't think so. —Preceding unsigned comment added by 131.96.91.71 ( talk) 13:14, 27 July 2010 (UTC)
This is a job I've left for much too long, but I've decided to review the content of the article with the help of Bosch. The source has been around for a while, but I've never quite taken the time to implement its main points fully.
I have removed doi:10.1016/S0140-6736(01)05950-5 as a source. It is cited as evidence that tasers cause rhabdomyolysis, but this is an aside in this commentary and speaks only of "mild rhabdomyolysis". Some other unreliable sources will be removed also. JFW | T@lk 21:51, 16 February 2011 (UTC)
Schedule for updating:
This should one day become an FA candidate, but let's bring it up to date first. JFW | T@lk 11:01, 21 February 2011 (UTC)
I had a look through the Cochrane database of systematic reviews ( protocol for CVVH review). There are currently no reviews available, just as the only guideline available for rhabdomyolysis seems to be from Finland. That leaves the recent reviews, most of which we seem to have covered now. JFW | T@lk 17:47, 15 April 2011 (UTC)
Hey Doc:
I went through Rhabdomyolysis rather carefully, and compiled the following list of ideas, suggestions, nitpicks, etc. - many of which may be wrong and/or cheesy, etc. In any case, I thought I'd just go ahead and throw them your way, to do with as you see fit. These aside, I must say HELLOVA GREAT JOB - EXCELLENT ARTICLE!
With very best regards, I remain
Your fan: Cliff L. Knickerbocker, MS ( talk) 17:57, 17 April 2011 (UTC)
REVIEW [sic] OF RHABDOMYOLYSIS
Respectfully submitted by: Cliff Knickerbocker, M.S. 17 April 2011
LEDE
SIGNS AND SYMPTOMS
TABLE OF CAUSES
PATHOPHYSIOLOGY
GENERAL INVESTIGATIONS
COMPLICATIONS
UNDERLYING DISORDERS
Acute Renal Failure Subsection
EPIDEMIOLOGY
I've done a PubMed search with rhabdomyolysis as a "major" topic and restricted to reviews. Naturally, a lot of reviews are disguised case reports. A few of the others (going back to 2005) are:
The peer review is still open, but it is probably time we get this towards FAC when that closes. JFW | T@lk 11:09, 3 May 2011 (UTC)
My attention was directed here by the FA nom; I find FA reviews annoyingly cluttered so I will discuss my issues here, if that's okay. Here is my first issue: in the Mechanism section, there is a line saying "those cells that survive react by pumping sodium ions out of the cells in exchange for calcium ions (through the sodium-calcium exchanger)". Is this correct? Normally the sodium-calcium exchanger pumps calcium out driven by the gradient of sodium flowing in. Looie496 ( talk) 17:30, 23 May 2011 (UTC)
The Bible section contains "traveling" (US) and "travelled" (UK). Aa77zz ( talk) 20:14, 23 May 2011 (UTC)
Should the 2010 Haiti earthquake be mentioned in this article? Possible sources include [4] and [5], but the sources are thin, probably because it was so WP:RECENT (relative to the academic publishing schedule). What do you think? WhatamIdoing ( talk) 00:27, 24 May 2011 (UTC)
On FAC, both Axl ( talk · contribs) and Casliber ( talk · contribs) have now stated that the article does not meet WP:WIAFA without a reshuffle of the "causes" section. I have taken this discussion to various places to get a better idea of what people regard as a well-classified list of information (e.g. WT:MED, WT:MEDMOS). The responses have been limited. I am being guided by Axl's suggestion that we take the framework of a good secondary source. He recommended the Oxford Textbook of Medicine and was good enough to provide a table from that source ( diff) although I am unsure which edition it was taken from. I have accessed the most recent edition ( ISBN 0199204853, 5th edition), which has a similar but different table in chapter 21.5 (box 21.5.4). It uses a grouping that seems to roughly follow the surgical sieve. I am veering towards using the classification of either NEJM (but lifting out the genetic causes for separate treatment) or Warren.
Warren uses (table 1):
I do not plan to mention the elaborate subclassification on myocyte level that Warren uses, mainly because it is highly technical and secondly because most of it seems to be based on a degree of speculation. JFW | T@lk 09:13, 5 June 2011 (UTC)
Due to space constraints the article does not contain a more detailed desciption of the historical and toxicological context of coturnism (rhabdomyolysis after eating quail). I have just discovered doi:10.1001/jama.1970.03170070056017 (JAMA 1970) which traces most of the reports back to the 1940s in Algeria.
Sheredot ( talk · contribs) added a reference to a report that suggested that Stachys annua was the toxic plant involved ( doi:10.1080/08873638709478507) rather than hemlock. This is not consistent with other reports ( doi:10.1503/cmaj.1031256 - CMAJ 2004) that implicates hemlock and Galeopsis laudanum and doi:10.1021/jf902764n (J Agric Food Chem) that exonerates Slachys and Galeopsis.
It would be helpful to have a secondary source available that can support any further additions to the article (see WP:MEDRS). JFW | T@lk 13:31, 24 June 2011 (UTC)
The important point is that the hemlock myth, which has been around for 2,000 years, is known to be false. It is a fundamental point that whatever the poison, or plant source, the quail eat it without ill effect. Any plant that poisons quail must be excluded. This must also throw doubt on using rats as a useful experimental animal. How does one know whether they are like humans or like (migrating) quail. Do quail, as I suspect, have a different metabolism when migrating? Sheredot ( talk) 09:13, 26 June 2011 (UTC)
These subsequent reports merely assume the hemlock cause they provide no evidence. Problems with hemlock poisoning come in in four areas (1) Hemlock seed kills quail, (2) Hemlock produces a sharp appetite depressant effect in quail, (3) Quail are toxic when hemlock seed is not available for consumption, and (4) Cotumix cannot accumulate toxic elements in hemlock seed. see Toxic quail: A cultural‐ecological investigation of coturnism.Bruce W. Kennedy & Louis Evan Grivetti Ecology of Food and Nutrition Volume 9, Issue 1, January 1980, pages 15-41 Ancient Greeks Aristotle, Galen etc. are c.2000 yrs ago Sheredot ( talk) 10:29, 29 June 2011 (UTC)
This is a separate article. It also refers to the condition as "Bywater's syndrome". This article ought to be either incorporated, or linked in some way. Amandajm ( talk) 13:09, 20 September 2011 (UTC)
Checking up on the template addition by a previous editor and adding a discussion area. Separate from the other conversation above about coturnism as a topic in this article, the Contradict-other template appears valid as there is a WP issue with two contradictory articles - coturnism directly contradicts the information given here. Thanks for helping! Universaladdress ( talk) 03:30, 20 April 2012 (UTC)
doi:10.1097/CND.0b013e31822721ca is a review specifically about exertional RM. The abstract and references look good, but I need to get hold of the fulltext before deciding to include it. JFW | T@lk 01:41, 7 October 2012 (UTC)
Is there a cure out for this disease? My fiancee's 7 yr old brother may have this disease. Is there anything out today that will reverse the affects of this? Neurontin/gabapentin maybe? — Preceding unsigned comment added by Sethwede1230( talk • contribs) 21:23, 13 December 2012 (UTC)
We cannot offer medical advice. Please see
the medical disclaimer, and contact an appropriate medical professional. --
Scray (
talk)
02:33, 14 December 2012 (UTC)
just added some more pictures and strategies for prevention.
Just want to explain why there was an addition to the treatment section. It is part of a project for a college class. Just a heads up! — Preceding unsigned comment added by MikalaB ( talk • contribs) 23:25, 21 May 2013 (UTC)
We needed to add our own research to the page for a college class assignment.
doi:10.1001/jamainternmed.2013.9774 is a nice paper using data of 1000s of patients to derive and validate a risk score for RRT or death in those with CK>5000 within 3 days of admission. I'm pretty sure that it will very soon be reflected in secondary sources. The risk score is based on age, sex (prognosis worse in females), the initial creatinine, calcium, CK (>40,000 is worse), underlying cause (prognosis better in seizures, syncope, exercise, statins, or myositis), and initial phosphate and bicarbonate.
I won't currently reference the article, but will monitor the secondary sources for mention. JFW | T@lk 11:08, 3 September 2013 (UTC)
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