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myoglobinuria

ICD-10 Codes

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Description

Myoglobinuria is a medical condition characterized by the presence of myoglobin in the urine, which usually results from rhabdomyolysis or muscle injury [2]. Myoglobin is a protein found in muscle cells that serves as an oxygen reserve [4].

The symptoms of myoglobinuria include brown to dark-red urine and the absence of red blood cells (RBCs) in the urine sediment [1]. A positive finding on testing for occult blood can also be present [1].

Myoglobinuria typically follows excessive release of myoglobin from muscles during periods of rapid muscle destruction, such as rhabdomyolysis [3]. This condition can be caused by various factors, including genetic recurrent myoglobinuria, which is an inborn error of metabolism characterized by abnormal urinary excretion of myoglobin due to acute destruction of skeletal muscles [5].

In more severe cases, myoglobinuria can lead to renal complications. A rare metabolic myopathy characterized by episodic myalgia with myoglobinuria induced by fever, viral or bacterial infection, and other factors has also been reported [8].

A myoglobin test measures the amount of myoglobin in the blood or urine, which can indicate muscle damage or disease [7]. The presence of myoglobin in the urine is a key diagnostic feature of myoglobinuria [10].

References: [1] Context result 1 [2] Context result 2 [3] Context result 3 [4] Context result 4 [5] Context result 5 [7] Context result 7 [8] Context result 8 [10] Context result 10

Additional Characteristics

  • Rhabdomyolysis
  • Myoglobinuria
  • Muscle injury
  • Brown to dark-red urine
  • Absence of red blood cells (RBCs) in the urine sediment
  • Positive finding on testing for occult blood
  • Genetic recurrent myoglobinuria
  • Inborn error of metabolism
  • Acute destruction of skeletal muscles
  • Renal complications
  • Metabolic myopathy

Signs and Symptoms

Myoglobinuria, also known as myoglobinemia, is a condition characterized by the presence of myoglobin in the urine. Myoglobin is a protein that stores oxygen in muscles. When muscle damage occurs, such as in rhabdomyolysis, myoglobin can leak into the bloodstream and eventually end up in the urine.

The signs and symptoms of myoglobinuria include:

  • Swollen and painful muscles: Muscle damage can cause inflammation and pain, leading to swelling.
  • Fever, nausea: Systemic symptoms such as fever and nausea can occur due to the body's response to muscle damage.
  • Delirium (elderly individuals): In elderly patients, myoglobinuria can lead to confusion, agitation, and delirium.
  • Myalgia: Muscle pain is a common symptom of myoglobinuria.
  • Dark urine: The presence of myoglobin in the urine can cause it to appear dark or tea-colored.

These symptoms can occur within 24 hours of the acute episode of muscle damage. It's essential to seek medical attention immediately if you experience any of these symptoms, as prompt treatment is crucial to prevent further complications.

References:

  • [2] Myoglobinuria is usually the result of rhabdomyolysis or muscle destruction.
  • [3] Myoglobinuria will usually occur within 24 hours of the acute episode.
  • [4] Nonspecific symptoms - eg, fever, malaise, anorexia, nausea and vomiting. Elderly patients may present with confusion, agitation and delirium.
  • [5] The classical triad of symptoms of rhabdomyolysis includes myalgia, muscle weakness, and dark urine.
  • [6] The main rhabdomyolysis (rhabdo) symptoms are muscle pain, dark urine, and feeling weak or tired.

Additional Symptoms

Diagnostic Tests

Myoglobinuria, also known as myoglobinemia when measured in blood, is a condition where myoglobin is present in the urine or blood. It can be caused by muscle damage, such as rhabdomyolysis.

Diagnostic tests for myoglobinuria:

  • Urine Myoglobin Test: This test measures the amount of myoglobin in the urine to detect its presence and assess kidney injury in patients with rhabdomyolysis [1][3].
  • Blood Myoglobin Test: This test measures the amount of myoglobin in the blood, which can also indicate muscle damage [4].
  • Creatine Kinase (CK) Levels: Measuring CK levels is another important laboratory test to assess for rhabdomyolysis and muscle damage [1].

Distinguishing Hemolysis from Myoglobinuria:

  • A positive urine benzidine test (>500 ng/mL myoglobin) without microscopic red blood cells can help distinguish hemolysis (red blood cell breakdown) from myoglobinuria [7].
  • If the urine sediment has a normal color and tests negative for red blood cells, it may indicate myoglobinuria rather than hemolysis [7].

Clinical Practice:

  • In clinical practice, direct assays for urine myoglobin are rarely done and not essential for diagnosis [8].
  • Visual and microscopic examination of the urine can also help diagnose myoglobinuria [8].

References:

[1] Oct 6, 2023 — The most important laboratory test is measurement of creatine kinase (CK) levels to assess for rhabdomyolysis. [2] Feb 28, 2023 — The myoglobin urine test is done to detect the presence of myoglobin in urine. Myoglobin can also be measured with a blood test. [3] by RB Schifman · 2019 · Cited by 12 — Context.—: Urine myoglobin testing is primarily indicated for diagnosis and risk assessment of kidney injury in patients with rhabdomyolysis. [4] A myoglobin test measures the amount of myoglobin, a protein found in your skeletal and heart muscles, in your blood or urine. High levels indicate muscle ... [5] At myoglobin levels of 100 mg/dL, urine tests positive for heme by dipstick after centrifugation, whereas the sediment has normal color and tests negative for ... [6] by RB Schifman · 2019 · Cited by 12 — Urine myoglobin testing is primarily indicated for diagnosis and risk assessment of kidney injury in patients with rhabdomyolysis. [7] Hemolysis is distinguished from myoglobinuria by a positive urine benzidine test (>500 ng/mL myoglobin) without microscopic red blood cells. Furthermore, if ... [8] by S Bhai · Cited by 7 — A direct assay for urine myoglobin is rarely done in clinical practice and is not essential for the diagnosis. The visual and microscopic ...

Additional Diagnostic Tests

  • Urine Myoglobin Test
  • Blood Myoglobin Test
  • Creatine Kinase (CK) Levels

Treatment

Myoglobinuria, also known as myoglobinemia, is a condition where myoglobin, a protein found in muscle tissue, is present in the urine. The treatment for myoglobinuria typically involves hydration and alkalinization to prevent renal failure.

Fluid Rehydration Prompt fluid rehydration is essential in treating myoglobinuria [5]. This helps to reduce the precipitation and toxicity of myoglobin at the site of injury, thereby preventing further kidney damage.

Alkalinization Administration of bicarbonate to alkalinize the urine can also be beneficial in treating myoglobinuria [4]. This helps to prevent renal failure by reducing the concentration of myoglobin in the urine.

Other Treatments In some cases, infusion of mannitol and sodium bicarbonate may be effective in treating patients with myoglobinuria [2][7]. However, it's essential to note that these treatments should only be administered under medical supervision.

Prevention of Renal Failure The primary goal of treatment is to prevent renal failure by maintaining adequate urine output and preventing further kidney damage. Vigorous fluid resuscitation is crucial in achieving this goal [4].

It's worth noting that the treatment for myoglobinuria may vary depending on the underlying cause and severity of the condition. In some cases, medications used to treat secondary complications from COVID-19 infection, such as meropenem, may also be necessary [9]. However, these should only be administered under medical supervision.

References: [2] by JF Eneas · 1979 · Cited by 268 [4] [5] Fluid rehydration - needs to be prompt; this is the most important aspect of treatment, as it will lead to less precipitation and toxicity of myoglobin at the ... [7] by JF Eneas · 1979 · Cited by 268 [9] Medications used to treat the infection, such as meropenem, and secondary complications from the COVID-19 infection, such as hypoxia and hypercoagulability, ...

Recommended Medications

  • Fluid Rehydration
  • Alkalinization
  • Infusion of mannitol and sodium bicarbonate

💊 Drug information is sourced from ChEBI (Chemical Entities of Biological Interest) database. Always consult with a healthcare professional before starting any medication. Click on any medication name for detailed information.

Differential Diagnosis

Myoglobinuria, also known as myoglobinemia, is a condition where an excessive amount of myoglobin is found in the urine. The differential diagnosis of myoglobinuria involves identifying the underlying causes of this condition.

Causes of Myoglobinuria

  • Rhabdomyolysis: This is the most common cause of myoglobinuria, which occurs when there is a breakdown of skeletal muscle fibers and cell membranes, releasing myoglobin into the bloodstream and eventually into the urine. [8][9]
  • Muscle injury or trauma: Physical injuries to muscles can lead to myoglobinuria.
  • Idiopathic recurrent myoglobinuria: This is a rare condition where myoglobinuria occurs without any apparent cause.

Other Conditions with Similar Symptoms

  • Hemoglobinuria: This condition involves the presence of hemoglobin in the urine, which can be mistaken for myoglobinuria. However, hemoglobinuria typically presents with a different set of symptoms and laboratory findings.
  • Myopathy with Myalgia, High CK ± Rhabdomyolysis (MMCKR1): This is a condition characterized by muscle weakness, pain, and elevated creatine kinase levels, which can be associated with myoglobinuria.

Diagnostic Approaches

To diagnose myoglobinuria, healthcare providers may use various tests, including:

  • Urinalysis: To detect the presence of myoglobin in the urine.
  • Blood tests: To measure creatine kinase (CK) and other muscle enzyme levels.
  • Imaging studies: Such as MRI or CT scans to evaluate muscle damage.

References

[1] Oct 6, 2023 — Differential Diagnoses · Asthma · Bacteremia · Birth Trauma · Dehydration in Children · Down Syndrome · Head Trauma · Hypercalcemia in Emergency ... [5] Differential diagnosis. The differential diagnosis of myoglobinuria includes two aspects. [8] by WS David · 2000 · Cited by 99 — Myoglobinuria refers to an abnormal pathologic state in which an excessive amount of myoglobin is found in the urine, imparting a cola-like hue. [9] Rhabdomyolysis can be defined as a clinical syndrome associated with the breakdown of skeletal muscle fibres and myocyte cell membranes.

Additional Differential Diagnoses

  • Rhabdomyolysis
  • Muscle injury or trauma
  • Idiopathic recurrent myoglobinuria
  • Myopathy with Myalgia, High CK ± Rhabdomyolysis (MMCKR1)
  • hemoglobinuria
  • ochronosis

Additional Information

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