- Things to Know
- Signs & Symptoms
- When to Seek Help
Things to know about rhabdomyolysis
- Rhabdomyolysis is the rapid destruction of skeletal muscle resulting in leakage into the urine of the muscle protein myoglobin.
- Rhabdomyolysis has many causes.
- Medications can cause muscle injury and rhabdomyolysis.
- Rhabdomyolysis can cause muscle pain and weakness.
- Blood levels of muscle enzymes, including CPK, SGOT, SGPT, and LDH, as well as blood and urine myoglobin are used to diagnose and monitor rhabdomyolysis.
- Hospitalization is sometimes required to treat rhabdomyolysis.
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) and also in the muscle cells. The level of each of these proteins can be measured in the 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:
- 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, extreme workouts)
- 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)
- Haff disease
What are the symptoms of rhabdomyolysis?
- Rhabdomyolysis may not cause any symptoms at all.
- Muscle aches and pain (myalgia), stiffness, and muscle weakness can occur with rhabdomyolysis and is especially common with severe muscle damage.
- Rhabdomyolysis may cause a darkening of the urine color.
- Myoglobin is released from the muscles when they break down and is excreted into the urine. This can cause a red or cola color in the urine.
What should I do if I think I have rhabdomyolysis?
If you have signs and symptoms suggestive of rhabdomyolysis, your doctor needs to be notified promptly. It is important to realize that these symptoms are not specific to rhabdomyolysis as they may be caused by other conditions.
How do medical professionals diagnose rhabdomyolysis?
Rhabdomyolysis is suggested by the history of recent and past events and the physical examination. It is confirmed by blood and urine testing. An important part of diagnosing rhabdomyolysis is a comprehensive medical history and physical examination.
- The medical history may include questions about any medication use, drug and alcohol use, other medical conditions, any trauma or accident, etc. Blood tests include a complete blood count (CBC), a metabolic panel, muscle enzymes, and urinalysis.
- The levels of myoglobin can be elevated in blood and urine
- The diagnosis of rhabdomyolysis is confirmed by detecting elevated muscle enzymes in the blood, which include creatine phosphokinase (CPK), SGOT, SGPT, and LDH. The levels of these enzymes rise as the muscle is destroyed in rhabdomyolysis.
- While the SGOT, SGPT, and LDH enzymes are found in muscles, they are more frequently associated with the liver. Therefore, elevations of SGOT and SGPT, without elevated CPK, are more typically indications of liver damage.
Of note, CPK is also in the heart muscle (cardiac muscle) and brain. The laboratory is usually able to distinguish between the different components of this enzyme. For example, the fraction coming from skeletal muscle is referred to as CK-MM and the one from heart muscle is designated as CK-MB. There are small amounts of the CK-MB component in the skeletal muscle as well.
What are the complications of rhabdomyolysis?
- One of the dreaded complications of rhabdomyolysis is kidney failure. This can occur for a variety of reasons. Direct injury to the kidney and plugging of the filtering tubes of the kidneys by the muscle proteins are among the causes of kidney function impairment in the setting of rhabdomyolysis.
- Another serious complication of rhabdomyolysis is called compartment syndrome where muscle injury leads to swelling and increased pressure in a confined space (a compartment). This leads to compromised circulation which can endanger the affected tissue. The compartment syndrome is most common after injury in the lower leg, arms, or the muscles of the abdominal wall and can require emergency surgery.
- Rhabdomyolysis can also cause an abnormality of electrolytes in the blood. Because of muscle injury, the contents of the muscle cells can be released into the blood causing high levels of potassium (hyperkalemia) and phosphorus (hyperphosphatemia).
What is the treatment for rhabdomyolysis?
The treatment of rhabdomyolysis depends on its cause and severity.
If a cause for rhabdomyolysis is identified, it is addressed; for example:
- discontinuing a toxic medication,
- replacing electrolytes, or
- treating an underlying muscle disease.
In cases of mild rhabdomyolysis without any evidence of complications, management can take place at home by simply recognizing the cause and correcting it, such as discontinuing medication and rehydration.
In more severe cases, or if home therapy is not possible, hospitalization may be required. Prompt initiation of hydration with intravenous fluids, in addition to the removal of the provoking factor(s), is an essential part of the treatment of rhabdomyolysis. Monitoring and managing kidney dysfunction, correcting any disturbance in the electrolytes, and monitoring the muscle enzyme levels (CPK, SGOT, SGPT, LDH) are most effectively done in the hospital when rhabdomyolysis is severe.
What is the prognosis for rhabdomyolysis?
Shefner, Jeremy M. "Clinical Manifestations and Diagnosis of Rhabdomyolysis." May 10, 2022. UpToDate.com. <https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-rhabdomyolysis>.
Top Rhabdomyolysis Related Articles
CancerCancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Complete Blood Count (CBC)A complete blood count (CBC) is a calculation of the cellular makeup of blood. A CBC measures the concentration of white blood cells, red blood cells, platelets in the blood, and aids in diagnosing conditions and disease such as malignancy, anemia, or blood clotting problems.
Creatinine Blood TestCreatinine is a chemical waste molecule that is generated from muscle metabolism. Creatinine is produced from creatine, a molecule of major importance for energy production in muscles. Creatinine has been found to be a fairly reliable indicator of kidney function. As the kidneys become impaired the creatinine level in the blood will rise. Normal levels of creatinine in the blood vary from gender and age of the individual.
DialysisDialysis is a procedure that performs many of the normal duties of the kidneys, like filtering waste products from the blood, when the kidneys no longer work adequately. There are two types of dialysis: Hemodialysis uses a filter to remove waste products and water from the body; and peritoneal dialysis removes excess waste and fluid with a fluid that is placed into the patient's stomach cavity through a special plastic tube.
Drug Abuse and AddictionDrug abuse and addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
Healthy Aging: Causes of Muscle WeaknessFrom aging to illness, many things can cause your muscles to get weaker. Learn about the causes and what you can do to make it better.
HypothyroidismHypothyroidism is any state in which thyroid hormone production is below normal. Normally, the rate of thyroid hormone production is controlled by the brain by the pituitary gland. Hypothyroidism is a very common condition and the symptoms of hypothyroidism are often subtle but may include constipation, memory loss, hair loss, and depression. There are a variety of causes of hypothyroidism, and treatment depends on the cause.
Kidney (Renal) Failure
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, or medication. Some of the renal causes of kidney failure include sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis.
Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones.Treatment options included diet, medications, or dialysis.
Kidneys PictureThe kidneys are a pair of organs located in the back of the abdomen. See a picture of the Kidneys and learn more about the health topic.
Muscle CrampsMuscle cramps are involuntarily and forcibly contracted muscles that do not relax. Extremely common, any muscles that have voluntary control, including some organs, are subject to cramp. Since there is such variety in the types of muscle cramps that can occur, many causes and preventative medications are known. Stretching is the most common way to stop or prevent most muscle cramps.
Muscle Cramps (Charley Horse) and Muscle SpasmsWhat are the differences between muscle spasms and cramps? Learn about the causes of muscle spasms and cramps (charley horse) in the calf, leg, and more.
Muscle SpasmsMuscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Pain Management: Why Does My Calf Muscle Hurt?There's a group of muscles on the back of each lower leg that doctors call "calf muscles." They play a key role in helping you walk and run. Learn the things that can make them hurt, from a minor sprain to more serious problems like deep vein thrombosis.
Pain Management: Signs Your Muscle Pain Is Something ElseCould your achy muscles be a sign of more than a tough workout? Learn when a twinge might warrant a visit to the doctor's office.
Urinalysis (Urine Test)Urinalysis (urine test, drug test) is a test performed on a patient's urine sample to diagnose conditions and diseases such as urinary tract infection, kidney infection, kidney stones, and inflammation of the kidneys, or screen for progression of conditions such as diabetes and high blood pressure.