[Traumatic, ischemic and toxic rhabdomyolysis].

Rhabdomyolysis with myoglobinuria and acute renal failure can develop from a variety of traumatic and nontraumatic reasons and the clinical as well as forensic significance of it may vary from an epiphenomenon with an excellent prognosis to the cause of death. We present altogether four autopsy cases in two of which the rhabdomyolysis was associated with an acute intoxication with alcohol (male, 41 years of age) or amitriptyline in combination with chlordiazepoxide (male, 52 years of age). In both these subjects the myoglobinuria was a secondary finding and not the cause of death. In the other two subjects the outcome of rhabdomyolysis associated myoglobinuria was lethal. In the first one (female, 18 years of age) the muscle injury was traumatic, caused by long-lasting compression and ischaemia of the lower limbs (classical crush-syndrome), the outcome of which in spite of the adequate therapy was lethal. In the other one (male, 20 years of age) the rhabdomyolytic myoglobinuria and subsequent acute renal failure occurred postoperatively after reconstructive surgery of one hand and the interruption of blood circulation to the corresponding arm for the time of a nerve reconstruction. The recovery of the patient was complicated by continuing electrolyte disturbances associated with metastatic tissue calcification, especially of the lungs, leading to progressive respiratory insufficiency and eventually to death.