Rhabdomyolysis

Rhabdomyolysis is a serious syndrome due to a direct or indirect muscle injury. It results from the death of muscle fibers and release of their contents into the bloodstream.

Causes of Rhabdomyolysis #

Traumatic causes #

• A crush injury such as from an auto accident, fall, or building collapse

• Long-lasting muscle compression such as that caused by prolonged immobilization after a fall or lying unconscious on a hard surface during illness or while under the influence of alcohol or medication

• Electrical shock injury, lightning strike, or third-degree burn

• Venom from a snake or insect bite

Nontraumatic causes #

• The use of alcohol or illegal drugs such as heroin, cocaine or amphetamines

• Extreme muscle strain, especially in someone who is an untrained athlete; this can happen in elite athletes, too, and it can be more dangerous if there is more muscle mass to break down.

• The use of medications such as antipsychotics or statins, especially when given in high doses

• A very high body temperature (hyperthermia) or heat stroke

• Seizures or delirium tremens

• A metabolic disorder such as diabetic ketoacidosis

• Diseases of the muscles (myopathy) such as congenital muscle enzyme deficiency or Duchenne’s muscular dystrophy

• Viral infections such as the flu, HIV, or herpes simplex virus

Symptoms of Rhabdomyolysis #

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.

Other common signs of rhabdomyolysis include:

• Abdominal pain

• Nausea or vomiting

• Fever, rapid heart rate

• Confusion, dehydration, fever, or lack of consciousness

Diagnosis of Rhabdomyolysis #

• Blood tests for creatine kinase, a product of muscle breakdown, and urine tests for myoglobin, a relative of hemoglobin that is released from damaged muscles, can help diagnose rhabdomyolysis (although in half of people with the condition, the myoglobin test may come up negative).

• Other tests may rule out other problems, confirm the cause of rhabdomyolysis, or check for complications.

Treatment of Rhabdomyolysis #

• 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.