What's to know about rhabdomyolysis?

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Rhabdomyolysis is when skeletal muscle breakdown occurs, which leads to a leakage of muscle components such as myoglobin into the bloodstream. Serious complications can occur including kidney damage and kidney failure.

These components then enter the bloodstream, where some can lead to kidney damage, with the most common being the protein pigment myoglobin.

Myoglobin can block the complex tubing system of the kidneys. If blockages become severe enough, kidney damage and failure can occur. Other cellular enzymes, especially creatine kinase (CK), also stress the kidney.

Damaged muscle tissues also retain body fluids. This can cause dehydration as well as reduce the flow of blood to the kidney, thereby increasing the risk of organ damage.

The complications associated with rhabdomyolysis depend on the severity of the case and several individual factors. Minor cases may not cause any noticeable symptoms. Severe cases often cause severe muscle pain and can be life threatening.

The most common cause of rhabdomyolysis is acute skeletal muscle injuries. However, anything that causes muscle injury, dehydration, or kidney injury increases a person’s chances of developing the condition.

There are many causes and risk factors for rhabdomyolysis that are currently recognized. These include the following:

• crushing damage to skeletal muscle tissues
• not being able to move for a prolonged period
• overexertion of muscles
• heatstroke
• hypothermia
• extensive burns that cause muscle damage
• hereditary muscle disorders
• infections, in particular, bacterial and viral infections that cause blood infections
• electrolyte disorders, especially those affecting potassium and calcium
• endocrine disorders, such as hypothyroidism and hyperthyroidism
• kidney disease or disorders
• heart attack or stroke, which can lead to muscle injury and not being able to move
• sickle cell anemia
• inflammatory muscle conditions

Medications

Certain medications can also lead to rhabdomyolysis, but this is rare. For example, statins carry an incredibly low risk of rhabdomyolysis. However, this risk can increase with dosage, physical exertion, and the presence of other triggering medications.

Other medications include anti-psychotic medications and those used to manage muscular conditions such as Parkinson’s disease.

Although mild cases may not cause symptoms, most people with rhabdomyolysis experience a common set of complaints. Injury-induced rhabdomyolysis symptoms may not appear until several days after the incident. However, symptom timing will vary between cases.

Common early symptoms of rhabdomyolysis include:

• muscle pain, often extremely painful aching, and throbbing
• muscle weakness
• muscle swelling or inflammation
• dark colored urine
• general exhaustion or fatigue
• irregular heartbeat
• dizziness, light-headed, or feeling faint
• confusion or disorientation
• nausea or vomiting

Medical attention should be sought any time that symptoms of rhabdomyolysis occur. Untreated cases can become serious and may cause life threatening complications such as kidney failure.

Most physicians begin by reviewing a patient’s medical history, considering factors including injury, overexertion, medication use, and other health conditions and symptoms.

Laboratory confirmation is typically necessary to confirm the diagnosis. This tends to involve the detection of elevated CK levels in the blood and the presence of myoglobin in the urine.

CK levels that are five times the upper limit of normal levels are evidence of rhabdomyolysis. The definition of normal CK levels in the blood varies by sex, race, and ethnicity.

Activity or physical exertion may raise CK levels temporarily. As a result, tests should not occur after avoiding rigorous activity for roughly 7 days.

Doctors often carry out muscle biopsies to confirm and assess muscle damage.

They may also perform genetic testing in people with suspected cases of rhabdomyolysis to check for the presence of inherited muscle conditions. Once additional conditions are confirmed, treatment is possible, reducing symptoms and the likelihood of the condition returning.

In most cases, people recover from rhabdomyolysis without further complications should they seek treatment promptly.

Treatment for mild cases may involve:

• rest
• drinking plenty of fluids
• avoiding excess heat and exertion

Treatment depends on the severity of the case, symptoms, and the presence of additional health complications that may increase the risk of kidney damage. In severe cases, kidney damage can be irreversible without early treatment.

One treatment method is intravenous fluid therapy. This involves the administration of large volumes of water to the veins for a period to rehydrate the body and flush out any myoglobin.

Other treatment options for severe rhabdomyolysis include urine alkalization and dialysis.

The easiest way to prevent rhabdomyolysis is to avoid prolonged heat exposure and excessive exertion and to stay hydrated.

Other common tips to help prevent the condition include:

• avoiding weight-loss, muscle gain, or performance-enhancing dietary supplements, especially those containing creatine, ephedrine, ephedra, or high levels of caffeine
• listening to one’s body when exercising and not going beyond what feels comfortable or natural to do
• seeking training advice if attempting a major physical event (such as running a marathon)
• increasing workout intensity and frequency slowly
• treating risk factors
• seeking immediate medical attention as soon as symptoms occur or if the condition is suspected

Rhabdomyolysis is when an injury causes skeletal muscle tissue breakdown and death. This causes the release of various substances into the blood that can damage the kidneys.

The condition can occur due to direct trauma injury, excess heat exposure and dehydration, and various infections and diseases.

A person’s outlook will depend on the severity of rhabdomyolysis and the speed of treatment administration.