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Volume 4
Clinical Pediatric Dermatology
ISSN: 2472-0143
Page 62
JOINT EVENT
Wound Congress 2018 &
Clinical Dermatology Congress 20
18
October 15-16, 2018
October 15-16, 2018 Rome, Italy
&
5
th
International Conference on
Advances in Skin, Wound Care and Tissue Science
14
th
International Conference on
Clinical Dermatology
the injured tissues. The first manifestation of the syndrome is usually hypoaemic shock, which is the most common cause of
death during the first 4 days after the injury. Hyperkalaemia with its effect on heart function is the second cause of premature
death. Myoglobin is a protein that accounts for 1-3% of the dry weight of the muscle tissue. Normally, myoglobin binds to
actoglobin and α-2 globin and is eliminated through the duodenal endothelial system. The saturation of aptoglobin (when a
large amount is produced of myoglobin) leads to an increase in free myoglobin in plasma that is excreted by the kidneys. In
the renal tubules, myoglobin forms casts, especially in acidic environment. Urine alkalinisation reduces the generation of these
complexes. Myoglobin causes immediate action in the renal tubules, helping to increase free radicals of oxygen and promoting
fat peroxidation. This action of myoglobin is also limited to alkaline environment. Patients usually experience: extensive
soft tissue injury with ischemia-reperfusion effect, edematous edges, compartment syndrome, dark-colored urine, positive
test for hemoglobin, absence of red blood cells in the urine, elevation of CPK levels in the blood. Management: Aggressive
fluid delivery; Administration of mannitol; Alkalisation of urine (pH> 6.5) with bicarbonate. In addition to alkalinisation of
urine, the positive action of bicarbonates is also due to the treatment of hyperkalaemia.; Hypocalcaemia should not be treated
aggressively because most of the calcium accumulates in muscles and exacerbates rhabdomyolysis.; Surgical cross-section of
the deep fascia, if the syndrome is manifested. Irreversible damage to muscle tissue and nerves is observed after 6-8 hours of
ischemia; Amputation of limbs in cases of extensive and irreversible damage to tissues.