Rhabdomyolysis after gastric bypass: severity and outcome patterns.
BACKGROUND
Rhabdomyolysis (RML) is a recently recognized complication of bariatric operations, but it is not known whether creatine kinase (CK) levels along with clinical markers are able to define the course and outcome.


METHODS
Bariatric patients (n=324) were reviewed retrospectively. Substantially elevated plasma CK after operation was identified in 4.9% (16/324). The affected population was divided into Group I (n=11, 68.8%) with CK 1050-8000 IU/L and no conspicuous muscle pain, weakness or swelling, and Group II (n=5, 31.2%) displaying CK >8000 IU/L and severe pain and dysfunction. The main outcome measures were CK concentration, frequency of renal failure, need for hemodialysis and mortality.


RESULTS
Group I subjects compared to Group II were younger (37.7 +/- 10.9 vs 44.0 +/- 5.5 years, P<0.05) and predominantly females (72.7% vs 40.0%, P<0.05). Peak CK values were definitely lower (2811 +/- 952 vs 28136 +/- 19000 IU/L, P<0.001), and none progressed to renal failure (0% vs 40.0%, P<0.05). No difference was detected regarding preoperative BMI (50.8 +/- 8.1 vs 54.6 +/- 7.0 kg/m(2), NS), duration of operation (5.3 +/- 1.6 vs 5.6 +/- 2.1 hours, NS) or types of anesthetic drugs (basically fentanyl, nitrogen oxide and halothane/isoflurane).


CONCLUSIONS
1) Demographic features, nominally gender and age, were different between the two degrees of RML; 2) Renal failure and hemodialysis were a danger only in patients with massive CK elevation and muscle pain; 3) Moderate CK increase was very well tolerated and rarely entailed major clinical symptoms; 4) Early diagnosis, fluid replenishment and general supportive therapy probably contributed to avert mortality.
Faintuch
Joel
J
Division of Gastrointestinal Surgery, Hospital das Clínicas, São Paulo University Medical School, São Paulo, Brazil. faintuch@net.ipen.br
de Cleva
Roberto
R
Pajecki
Denis
D
Garrido
Arthur B
AB
Cecconello
Ivan
I
D000328:Adult; D015331:Cohort Studies; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000201:enzymology / Q000601:surgery*; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000201:enzymology / Q000209:etiology*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D003402:Creatine Kinase