ACUTE RHABDOMYOLYSIS IN CHILDHOOD

Rhabdomyolysis results from muscular fibre lysis with release of cellu lar contents (myoglobin, enzymes, electrolytes) into the plasma. Traum atic (crush syndrome) and non-traumatic rhabdomyolysis have been mostl y reported in adults. Traumatic rhabdomyolysis are mostly due to ische mic and reperfusion injuries. Non-traumatic rhabdomyolysis include sev eral factors: muscular compression (comas) cytotoxic injury (infection s and poisonings), ischemia (shock, cardiorespiratory arrest) or exces sive muscular activity (seizures, strenuous exercise). The main etiolo gies reported in children are: anoxic-ischemic encephalopathy (includi ng sudden infant death and life threatening events); electrolyte disor ders; severe hyperthermia; poisonings; hereditary myopathies Non-traum atic rhabdomyolysis must be suspected in these circumstances requiring blood creatinine phosphokinase measurements. Indeed, clinical signs a re inconstant and non-specific, and functional signs are difficult to appreciate in children. During the initial phase, the main risk is arr hythmias secondary to hyperkalemia. The two main complications are the compartmental syndrome leading to irreversible vasculo-nervous injuri es and acute renal failure. Treatment of traumatic and nontraumatic rh abdomyolysis includes correction of hyperkalemia, active fluid loading in order to prevent acute renal failure and alkalinisation. Prognosis of rhabdomyolysis relates to the aetiology and the presence of acute renal failure. (C) 1998, Elsevier, Paris.