Internal Medicine Solution 09

Option D

Alcoholism is another common cause of rhabdomyolysis. This may be secondary to to alcohol related trauma, seizures, or coma, or may be due to a direct toxic effect of ethanol on skeletal muscle, resulting in both a chronic myopathy, and acute rhabdomyolysis

Alcohol directly injures the sarcolemma and increases sodium permeability. This in turn increases the activity of the Na+,K+-ATPase pump, with the eventual exhaustion of energy stores. Increased cytosolic Na+ enhances the accumulation of cytosolic Ca++, which in addition to increased mitochondrial Ca++ causes cellular injury. Analysis of skeletal muscle from chronic alcoholics and experimental animals fed ethanol shows a marked depletion of potassium, phosphorus, and magnesium, and elevated sodium, chloride, calcium and water content. Acute hypophosphatemia would shut off ATP synthesis.

Uniform muscle necrosis, leukocyte and macrophage invasion of degenerated muscle fibers are observed with light microscopy, and ultrastructural changes include the separation of myofibrils and other cellular elements by clear spaces.

Acute alcohol-induced rhabdomyolysis can occur after binge drinking or a sustained period of alcohol abuse, and is associated with pain and swelling of muscles, particularly the quadriceps.

Symptoms resolve if the patient abstains from alcohol use.

Category: Medicine MCQs