Rhabdomyolysis

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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Rhabdomyolysis (RAB-DOE-MY-O-LIE-SIS) is the rapid destruction of skeletal muscle resulting in leakage into the urine of the muscle protein myoglobin.

There are three different types of muscle in the human body;

1. smooth muscle,
   
   
2. skeletal muscle, and
   
   
3. heart muscle.

The skeletal muscle is the muscle of movement of the body (moving the skeleton at the joints). Skeletal muscle is affected by rhabdomyolysis.

Myoglobin is a protein component of the muscle cells that is released into the blood when the skeletal muscle is destroyed in rhabdomyolysis. Creatine kinase is an enzyme (a protein that facilitates chemical reactions in the body) also in the muscle cells. The level of each of these proteins can be measured in blood to monitor the degree of muscle injury from rhabdomyolysis. Myoglobin can also be measured in samples of urine.

Rhabdomyolysis has many causes. Some of the common ones include:

• muscle trauma or crush injury,
  
  
• severe burns,
  
  
• physical torture or child abuse,
  
  
• prolonged lying down on the ground (people who fall or are unconscious and are unable to get up for several hours),
  
  
• prolonged coma,
  
  
• severe muscle contractions from prolonged seizures,
  
  
• cocaine use with related hyperthermia (increased body temperature),
  
  
• extreme physical activity (running a marathon),
  
  
• drug and alcohol intoxication,
  
  
• low circulating phosphate, potassium, or magnesium levels in the blood (electrolytes),
  
  
• genetic muscle diseases (familial paroxysmal rhabdomyolysis),
  
  
• prolonged drowning or hypothermia (low core body temperature),
  
  
• medications: most notably statins used to treat high cholesterol [simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol), or lovastatin (Mevacor)] and other medications such as Parkinson's medication, psychiatric medications, anesthesia medications, HIV medications, colchicine,
  
  
• variety of viruses and some bacteria,
  
  
• severe hypothyroidism (low thyroid level), especially if the person is also taking statin drugs for cholesterol,
  
  
• lack of blood perfusion to a limb,
  
  
• some inflammatory disorders of the muscle, called myopathies, (myositis, dermatomyositis, polymyositis),
  
  
• venom from certain snake bites (mainly in Africa, Asia, and South America).