Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
One of the dreaded complications of rhabdomyolysis is
kidney failure. This can occur for a variety of reasons. Direct injury to the
kidney and plugging of the filtering tubes of the kidneys by the muscle proteins are among the causes
of kidney function impairment in the setting of rhabdomyolysis.
Another serious complication of rhabdomyolysis is called
the compartment syndrome whereby muscle injury leads to swelling and increased pressure in a
confined space (a compartment). This leads to compromised circulation which can
endanger the affected tissue. The compartment syndrome is most common after
injury in the lower leg or the
muscles of the abdominal wall and can require emergency surgery.
Rhabdomyolysis can also cause abnormality of
electrolytes in the blood. Because of muscle injury, the contents of the muscle
cells can be released into the blood causing high levels of potassium
(hyperkalemia) and phosphorus
(hyperphosphatemia).
How is rhabdomyolysis treated?
The treatment of rhabdomyolysis depends on its cause and severity.
If a cause for rhabdomyolysis is identified, it is addressed; for example:
discontinuing a toxic medication,
replacing electrolytes, or
treating an
underlying muscle disease.
In cases of mild rhabdomyolysis without any evidence of complications,
management can take place at home by simply recognizing the cause and correcting
it, such as discontinuing a medication and rehydration.
In more
severe cases, or if home therapy is not possible, hospitalization may be required. Prompt initiation
of hydration with intravenous fluids, in
addition to the removal the provoking factor(s), is an essential part of the
treatment of rhabdomyolysis. Monitoring and managing kidney dysfunction, correcting any disturbance in the electrolytes,
and monitoring the muscle enzyme levels (CPK, SGOT, SGPT, LDH) are most
effectively done in the hospital when rhabdomyolysis is severe.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Hyperkalemia is an abnormally high level of potassium in the blood. Symptoms of hyperkalemia include nausea, fatigue, tingling sensations, or muscle weakness. Hyperkalemia may also cause no symptoms. Slow heartbeat and weak pulse are more serious symptoms. Causes of hyperkalemia include kidney dysfunction, medications, adrenal gland diseases, and potassium shifts. Treatment of hyperkalemia is dependant upon the cause.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Drug addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
Burns are categorized by severity as first, second, or third degree. First degree burns are similar to a painful sunburn. The damage is more severe with second degree burns, leading to blistering and more intense pain. The skin turns white and loses sensation with third degree burns. Burn treatment depends upon the location, total burn area, and intensity of the burn.
Hypothermia is having a body core temperature of less than 35 C or 95 F. Most causes of hypothermia are preventable. Risk factors for hypothermia include age, mental status, medical conditions, and medications. Symptoms of hypothermia generally depend upon the severity of the condition. Treatment depends upon the severity of hypothermia. If not treated early, hypothermia can lead to cardiac arrest, coma, or death.
Coma is the inability to waken or react to the surrounding environment. The Glasgow Coma Scale is frequently used to measure the depth of coma. Causes of coma include trauma, bleeding, edema, lack of oxygen, poisoning, or hypoglycemia. Prognosis for a patient in a coma depends on the cause of the coma.
Child abuse falls into four categories: neglect, physical abuse, sexual abuse, and emotional abuse. There are certain risk factors that predispose a child to being abused and an adult to abusing a child. Risk factors for children are age, children with learning disabilities, adopted and foster children, children with congenital abnormalities, and a past history of abuse. Parental risk factors include young or single parents, those who suffered abuse themselves, adults with substance-abuse problems or psychiatric disease, and those who didn't graduate from high school.
Compartment syndrome is a condition in which swelling and an increase in pressure within a limited space presses and compresses blood vessels, nerves, or tendons that run through the compartment. There are two types of compartment syndrome, acute compartment syndrome is treated with surgery (fasciotomy) and chronic compartment syndrome, which is treated with rest and modality to the affected limb. Symptoms of compartment syndrome include pain, change in sensation, change in color, paralysis, or numbness in the affected limb.
Seizures are divided into two categories: generalized and partial. Generalized seizures are produced by electrical impulses from throughout the brain, while partial seizures are produced by electrical impulses in a small part of the brain. Seizure symptoms include unconsciousness, convulsions, and muscle rigidity.
Cholesterol is the most common type of steroid in the body. The treatment of elevated cholesterol involves not only diet but also weight loss, regular exercise, and medications. By understanding your cholesterol profile you can better manage your cholesterol levels.
Hyperthermia is the overheating of the body. Heat-related illnesses like heat stroke, heat exhaustion, heat cramps, heat rash, and sunburn are all hyperthermia conditions. Treatment of these conditions depends upon the condition, environment, and circumstances. Heat stroke is a medical emergency, and may result in death if not treated promptly. Heat exhaustion may lead to heat stroke if not treated properly.
Drowning is a common cause of death and disability worldwide. In the US, it is the third most common cause of accidental death. Brain damage, pneumonia, ARDS, hypothermia, and spine fractures are complications of drowning. At times, there are discussions of wet vs. dry, or salt vs. fresh water drownings. Children and young adults are at most risk for drowning accidents. Medical emergencies in the water may lead to drowning (such as seizures, hypoglycemia, sudden cardiac death, or heart attack). Treatment of a drowning victim depends up on the severity of the injury. Prevention is the key to prevent drowning.
Pet vipers are a family of poisonous snakes, which includes rattlesnakes, copperheads, and water moccasins (cottonmouths). Treatment of poisonous snake bites is possible, however, any victim of a venomous snake bite should be evaluated in an emergency medical care facility as soon as possible.
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