About rhabdomyolysis

What is rhabdomyolysis?

Rhabdomyolysis facts

  • Rhabdomyolysis is the rapid destruction of skeletal muscle resulting in leakage into the urine of the muscle protein myoglobin.
  • Rhabdomyolysis has many causes.
  • Medications can cause muscle injury and rhabdomyolysis.
  • Rhabdomyolysis can cause muscle pain and weakness.
  • Blood levels of muscle enzymes, including CPK, SGOT, SGPT, and LDH, as well as blood and urine myoglobin are used to diagnose and monitor rhabdomyolysis.
  • Hospitalization is sometimes required to treat rhabdomyolysis.

What is rhabdomyolysis?

Rhabdomyolysis (RAB-DOE-MY-O-LIE-SIS) is the rapid destruction of skeletal muscle resulting in leakage into the urine of the muscle protein myoglobin.

There are three different types of muscle in the human body;

  1. smooth muscle,
  2. skeletal muscle, and
  3. heart muscle.

The skeletal muscle is the muscle of movement of the body (moving the skeleton at the joints). Skeletal muscle is affected by rhabdomyolysis.

Myoglobin is a protein component of the muscle cells that is released into the blood when the skeletal muscle is destroyed in rhabdomyolysis. Creatine kinase is an enzyme (a protein that facilitates chemical reactions in the body) also in the muscle cells. The level of each of these proteins can be measured in blood to monitor the degree of muscle injury from rhabdomyolysis. Myoglobin can also be measured in samples of urine.

What are the symptoms for rhabdomyolysis?

Signs and symptoms of rhabdomyolysis may be hard to pinpoint. This is largely true because the course of rhabdomyolysis varies, depending on its cause. And, symptoms may occur in one area of the body or affect the whole body. Also, complications may occur in early and later stages.

The “classic triad” of rhabdomyolysis symptoms are: Muscle Pain in the shoulders, thighs, or lower back;  Muscle Weakness or trouble moving arms and legs; and dark red or brown urine or decreased urination. Keep in mind that half of people with the condition may have no muscle-related symptoms.

What are the causes for rhabdomyolysis?

Muscle injury always triggers rhabdo. However, in this case, “injury” doesn’t only refer to physical trauma — it can have physical, chemical, or genetic causes. Anything that severely damages the muscles can lead to rhabdo.

What are the treatments for rhabdomyolysis?

Early diagnosis and treatment of rhabdomyolysis and its causes are keys to a successful outcome. You can expect full recovery with prompt treatment. Doctors can even reverse kidney damage. However, if compartment syndrome is not treated early enough, it may cause lasting damage.

If you have rhabdomyolysis, you will be admitted to the hospital to receive treatment for the cause. Treatment with intravenous (IV) fluids helps maintain urine production and prevent kidney failure. Rarely, dialysis treatment may be needed to help your kidneys filter waste products while they are recovering. Management of electrolyte abnormalities (potassium, calcium and phosphorus) helps protect your heart and other organs. You may also need a surgical procedure (fasciotomy) to relieve tension or pressure and loss of circulation if compartment syndrome threatens muscle death or nerve damage. In some cases, you may need to be in the intensive care unit (ICU) to allow close monitoring.

Most causes of rhabdomyolysis are reversible.

If rhabdomyolysis is related to a medical condition, such as diabetes or a thyroid disorder, appropriate treatment for the medical condition will be needed. And if rhabdomyolysis is related to a medication or drug, its use will need to be stopped or replaced with an alternative.

After treatment, discuss with your doctor any needed limitations on diet or activity. And, of course, avoid any potential causes of rhabdomyolysis in the future.

What are the risk factors for rhabdomyolysis?

Trauma, heat, and exertion

Causes in this category include:

  • a crush injury, which can occur when something heavy falls on you
  • a heat stroke
  • a third degree burn
  • blocked blood vessels
  • a lightning strike
  • intense shivering
  • extreme muscle exertion
  • a car accident
  • intense exercise, such as marathon running

Genetic and metabolic disorders

Some people develop rhabdo due to genetic conditions, such as problems with the metabolism of:

  • lipids or fats
  • carbohydrates
  • purines, which are in certain foods, such as sardines, liver, asparagus

Metabolic problems, such as the following, can also trigger rhabdo:

  • hypothyroidism, or low thyroid hormone levels
  • diabetic ketoacidosis, or a buildup of ketones in the body
  • electrolyte imbalances

Genetic disorders that can lead to rhabdo include:

  • a carnitine deficiency
  • McArdle disease
  • a lactate dehydrogenase deficiency
  • Duchenne muscular dystrophy

Infection and inflammation

Many types of infection and inflammation can cause rhabdo, including:

  • viral infections, such as HIV and coxsackievirus
  • bacterial infections, such as salmonella
  • polymyositis
  • dermatomyositis
  • venomous snakebites and insect bites
  • eating poisonous mushrooms

Medications and toxins

One important cause of rhabdo is statin medications, which are cholesterol-lowering drugs that many people take. Statins include:

  • atorvastatin (Lipitor)
  • rosuvastatin (Crestor)
  • pravastatin (Pravachol)

Although rhabdo only occurs in a few people who take statins, it’s important to be aware of the risk since many people take these medications. In 2011 and 2012, around 26 percentTrusted Source of people in the United States took statins.

The condition can also occur due to exposure to other drugs, certain toxins, and high levels of alcohol.

Other drugs that can cause rhabdo include:

  • cocaine
  • amphetamines
  • ecstasy (MDMA)
  • cyclosporine
  • erythromycin
  • colchicine
  • LSD (acid)

There are many other potential causes. This is only a partial list.

Video related to rhabdomyolysis