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Rhabdomyolysis

By

Anna Malkina

, MD, University of California, San Francisco

Last full review/revision Mar 2020| Content last modified Mar 2020
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Topic Resources

Rhabdomyolysis occurs when muscle fibers damaged by disease, injury, or toxic substances break down and release their contents into the bloodstream. Severe disease can cause acute kidney injury.

Normal skeletal muscle function requires proper exchange of electrolytes (electrically charged minerals such as sodium and potassium) across muscle cells (myocytes). This exchange allows the cells to adequately metabolize adenosine triphosphate (ATP), a molecule necessary for transporting energy within cells and powering the body’s functions.

In rhabdomyolysis the processes that support the normal functioning of skeletal muscle are disrupted, so that myocytes break down and release some of their contents into the bloodstream, including

  • Creatine kinase (CK), a protein that rises when muscle is damaged

  • Myoglobin, an iron-containing protein that transports and stores oxygen in myocytes

  • Electrolytes

When the kidneys are functioning normally, they filter all myoglobin and excess creatine kinase out of the bloodstream through urination. High concentrations of myoglobin in the blood can overwhelm and damage the kidneys (causing acute kidney injury Acute Kidney Injury Acute kidney injury is a rapid (days to weeks) decline in the kidneys’ ability to filter metabolic waste products from the blood. Causes include conditions that decrease blood flow to the kidneys... read more ) and other organs.

Any form of muscle damage can result in rhabdomyolysis. The most common causes of that damage include

Some drugs and toxic substances (for example, statins Lipid-Lowering Drugs Dyslipidemia is a high level of lipids (cholesterol, triglycerides, or both) or a low high-density lipoprotein (HDL) cholesterol level. Lifestyle, genetics, disorders (such as low thyroid hormone... read more Lipid-Lowering Drugs ) can cause direct muscle damage. Other drugs and toxic substances raise levels of drugs that could damage muscle (for example, drug interactions involving antibiotics Overview of Antibiotics Antibiotics are drugs used to treat bacterial infections. They are ineffective against viral infections and most other infections. Antibiotics either kill microorganisms or stop them from reproducing... read more ). Still other drugs and toxic substances damage muscle indirectly by restricting blood supply to those muscles. For example, people who are sedated and immobile after taking drugs such as antianxiety agents Antianxiety and Sedative Drugs Antianxiety and sedative drugs are prescription drugs used to relieve anxiety and/or help with sleep, but their use can result in dependency and a substance use disorder. Using prescription... read more , antipsychotics Antipsychotic Drugs Psychosis refers to symptoms such as delusions, hallucinations, disorganized thinking and speech, and bizarre and inappropriate motor behavior that indicate loss of contact with reality. A number... read more , cocaine Cocaine Cocaine is an addictive stimulant drug made from leaves of the coca plant. Cocaine is a strong stimulant that increases alertness, causes euphoria, and makes people feel powerful. High doses... read more , amphetamines Amphetamines Amphetamines are stimulant drugs that are used to treat certain medical conditions, but are also subject to abuse. Amphetamines increase alertness, enhance physical performance, and produce... read more , or alcohol Alcohol Alcohol (ethanol) is a depressant. Consuming large amounts rapidly or regularly can cause health problems, including organ damage, coma, and death. Genetics and personal characteristics may... read more may stay in the same position for hours, which can lead to compression and damage of certain muscles and the blood vessels to those muscles.

Less common causes of rhabdomyolysis include

Symptoms of Rhabdomyolysis

The three classic symptoms of rhabdomyolysis are muscle pain, weakness, and reddish-brown urine (caused by the high levels of the red-pigmented protein myoglobin that is dumped into the blood). However, this trio of symptoms is present in less than 10% of all people with rhabdomyolysis.

The symptoms of rhabdomyolysis vary, and about 50% of people have no muscle complaints at all. When present, muscle pain tends to affect the shoulders, thighs, lower back, and calves.

At a high concentration, myoglobin excreted into the urine (myoglobinuria) changes the color of the urine to red or brown and can be confirmed with a urine test. However, a person can have rhabdomyolysis without also having discolored urine.

Other signs and symptoms depend on the cause of the original muscle injury as well as on the complications of that injury (for example, fever in people with infection or changes in alertness in intoxicated people).

Diagnosis of Rhabdomyolysis

  • A doctor’s evaluation

  • Blood and urine tests

Doctors suspect rhabdomyolysis based on symptoms. The diagnosis is confirmed by blood tests.

Sometimes additional laboratory testing to detect myoglobin in the urine is done to confirm the diagnosis.

Treatment of Rhabdomyolysis

  • Treatment of underlying cause

  • Treatment of complications

In general, treatment is aimed at the cause and any complications of rhabdomyolysis.

If compartment syndrome Compartment Syndrome Compartment syndrome is increased pressure in the space around certain muscles. It occurs when injured muscles swell so much that they cut off their blood supply. Pain in the injured limb increases... read more is the cause of the rhabdomyolysis, a surgical procedure called a fasciotomy is done to relieve pressure inside the muscle. Relieving this pressure helps to reestablish healthy circulation in the affected tissue. Infections are treated with the appropriate drugs. Any drugs suspected of causing the rhabdomyolysis (for example, statins) are stopped. Electrolyte disturbances Overview of Electrolytes Well over half of the body's weight is made up of water. Doctors think about the body's water as being restricted to various spaces, called fluid compartments. The three main compartments are... read more are corrected.

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