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 (kidney) failure. This means the kidneys cannot remove waste and concentrated urine. In rare cases, rhabdomyolysis can even cause death. However, prompt treatment often brings a good outcome. Here's what you need to know about rhabdomyolysis.
There are many traumatic and nontraumatic causes of rhabdomyolysis. In the first category, 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
Nontraumatic causes of rhabdomyolysis include:
- 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
- Bacterial infections leading to toxins in tissues or the bloodstream (sepsis)
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. 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.
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, 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.
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). About one in four also develop problems with their liver. A condition called compartment syndrome may also occur after fluid resuscitation. This serious compression of nerves, blood vessels, and muscles can cause tissue damage and problems with blood flow.
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.