Alcoholism and Immobility Induced Rhabdomyolysis Culminating in Hemodialysis

Abstract

Rhabdomyolysis is characterised by muscle breakdown and the release of myoglobin. It is a potentially serious condition that can lead to acute kidney injury (AKI). Factors, such as ischemia, trauma, muscle compression and drug toxicity, can trigger muscle breakdown. Treatment involves aggressive fluid resuscitation to maintain urine output and prevent renal injury. Severe cases with AKI may require temporary renal replacement therapy, such as haemodialysis. It has also been proposed that dialysis can speed up recovery by removing myoglobin that is secreted into the circulation by injured muscles. We present a case of a patient with alcohol abuse and prolonged immobility leading to severe rhabdomyolysis requiring hemodialysis. Our aim is to emphasise the importance of timely identification, and appropriate management of severe rhabdomyolysis not improving on fluids may require HD as soon as possible in order to minimise complications.

Keywords: acute kidney injury (aki); alcoholism; continuous renal replacement therapy (crrt); creatine kinase; hemodialysis; kidney injury; myoglobin; rhabdomyolysis.

Figure 1. CT abdomen and pelvis illustrating several nonspecific osteolytic lesions noted in the thoracolumbar spine centred at L2.

Figure 2. CT abdomen and pelvis demonstrating atrophy and cortical scarring involving the left kidney.

Figure 3. CT abdomen and pelvis illustrating several nonspecific osteolytic lesions noted in the bilateral iliac bones.

Figure 4. MRI lumbar spine demonstrating T1 and T2 intense lesions in the L2 likely representing intraosseous hemangioma.