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. This can lead to serious complications such as renal failure. This means the kidneys cannot remove waste and concentrated urine.

Rhabdomyolysis Causes

There are many traumatic and non-traumatic causes of rhabdomyolysis.

Traumatic causes include:

  • 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

Non-traumatic causes include:

  • The use of alcohol drugs such as heroin, cocaine or amphetamines
  • Extreme muscle strain, especially in someone who is an untrained athlete
  • The use of medications such as antipsychotics or statins, especially when given in high doses
  • A very high body temperature or heat stroke
  • Viral infections such as the flu, HIV, or herpes simplex virus
  • Bacterial infections leading to toxins in tissues or the bloodstream

A previous history of rhabdomyolysis also increases the risk of having rhabdomyolysis again.

Rhabdomyolysis Signs and Symptoms

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.

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 

Blood tests for creatine kinase (CK), a product of muscle breakdown, can help diagnose rhabdomyolysis.

Common complications of rhabdomyolysis include very high levels of potassium in the blood, which can lead to an irregular heartbeat or cardiac arrest and kidney damage (which occurs in up to half of patients). Compartment syndrome may also occur after fluid resuscitation.

This teaching session was based on a patient who had been spinning for the first time, had thigh pain and dark urine and an extremely high CK. His rhabdomyolysis developed into bi-lateral compartment syndrome and 6 hours after arrival in ED he was on ITU post-surgery after having a bi-lateral fasciotomy.

Rhabdomyolysis Treatments

Early diagnosis and treatment of rhabdomyolysis and its causes are keys to a successful outcome. You can expect full recovery with prompt treatment.

Treatment with intravenous (IV) fluids helps maintain urine production and prevent kidney failure. Management of electrolyte abnormalities (potassium, calcium and phosphorus) helps protect the heart and other organs.

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.

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