RAPID FALL IN BLOOD MYOGLOBIN IN MASSIVE RHABDOMYOLYSIS AND ACUTE-RENAL-FAILURE

Objective: Myoglobin kinetics of removal from the circulation were stu died in patients following massive rhabdomyolysis, to see if myoglobin remains for long in the circulation in the anuric state and if myoglo bin elimination was affected by therapeutic manipulation such as haemo filtration or haemodialysis. Design: Randomised and controlled study. Setting: Intensive care unit of a tertiary care teaching hospital. Pat ients: 26 patients of rhabdomyolysis whose serum myoglobin exceeded mo re than 500 nmol/l. Thirteen patients developed acute renal failure an d underwent treatment with blood purification (Group HD). The remainin g 13 patients did not require treatment with blood purification (contr ol subjects, Group non-HD). Interventions: In patients of group HD, tw elve were treated with haemofiltration and/or haemodialysis. One was t reated with peritoneal dialysis. The patient of group non-HD were trea ted with fluid infusion alone. Measurements and results. The serum con centrations of myoglobin were serially determined. The highest levels of myoglobin was 1641 +/- 484 nmol/l (mean +/- SEM) in the group non-H D and were 8957 +/- 2300 in the group HD. In the group non-HD, the blo od myoglobin fell exponentially once myoglobin release into the circul ation ceased. This was also noted in the group HD. The exponential dec rease was observed even on the days when the patient passed little uri ne or treatment with blood purification was not performed. Conclusion: In patients with massive myoglobinaemia, the blood myoglobin rapidly fell independent of renal function or any therapeutic manipulation. Th e results indicate that extrarenal factors played a major role in disp osing circulating myoglobin in such patients.