Paroxysmal Recurrent Rhabdomyolysis

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Abstract
Introduction Paroxysmal recurrent rhabdomyolysis has been suggested5 as a diagnostic term for the syndrome of acute dissolution of striated muscle without known cause, but sometimes precipitated by physical exertion, restriction of carbohydrates in the diet, infections, or fever. Alcohol and barbiturate intoxication have also recently been implicated in the precipitation of the attacks.16 The clinical picture of the disorder has been well described in several recent reviews.3,5,21,35,37,44 The acute attacks are characterized by the rapid onset of muscular weakness and muscular pain, mostly in proximal muscle groups, by fever, and by leukocytosis. The breakdown of muscle fibers is accompanied by the release into the circulation of such intracellular constituents as glycogen, myoglobin (myohemoglobin), creatine, and potassium. Death may occur at the height of the attack, owing to hyperkalemia, paralysis of respiratory muscles, or renal failure. Myoglobin is readily excreted by the kidney, provided that its concentration exceeds

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