Rhabdomyolysis
Medical Author: Siamak Nabili, MD, MPH
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
What is rhabdomyolysis?
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;
- smooth muscle,
- skeletal
muscle, and
- 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.
What causes rhabdomyolysis?
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).
Next: What are the symptoms of rhabdomyolysis? »
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Rhabdomyolysis
Hyperkalemia (High Blood Potassium) »
What is hyperkalemia?
Hyperkalemia is common; it is diagnosed in up to 8% of
hospitalized patients in the U.S. Fortunately, most patients have mild
hyperkalemia (which is usually well tolerated). However, any
condition causing even mild
hyperkalemia should be treated to prevent progression into more severe
hyperkalemia. Extremely high levels of potassium in the blood (severe
hyperkalemia) can lead to cardiac arrest and
death. When not recognized and treated properly, severe hyperkalemia results in
a mortality rate of about 67%.
Technically, hyperkalemia means an abnormally elevated level of potassium in the blood.
The normal potassium level in the blood is 3.5-5.0 milliequivalents per liter
(mEq/L). Potassium levels between 5.1 mEq/L to 6.0 mEq/L reflect mild hyperkalemia.
Potassium levels of 6.1 mEq/L to 7.0 mEq/L are moderate hyperkalemia, and levels
above 7 mEq/L are severe hyperkalemia.
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