What Causes Rhabdomyolysis?

Reviewed on 2/25/2021

What Is Rhabdomyolysis?

Rhabdomyolysis happens when severely damaged muscles (such as from intense physical activity or some medical condition) release protein molecules into the bloodstream that are too large and complex for the kidneys to break down.
Rhabdomyolysis happens when severely damaged muscles (such as from intense physical activity or some medical condition) release protein molecules into the bloodstream that are too large and complex for the kidneys to break down.

Rhabdomyolysis (“rhabdo”) occurs when muscle tissue becomes severely damaged and proteins and electrolytes from inside the muscle cells leak out into the blood. 

Rhabdomyolysis can range from asymptomatic and mild to severe and life-threatening.

What Are Symptoms of Rhabdomyolysis?

Rhabdomyolysis may cause no symptoms in some people. When symptoms of rhabdomyolysis occur, they may include:

  • Muscle pain, cramps, or aches
  • Muscle tenderness, swelling, and bruising 
  • Dark urine (red, brown, or tea-colored)
  • Muscle weakness
  • Tiredness
  • Inability to complete job tasks or finish a workout
  • Fever
  • Nausea
  • Vomiting
  • Feeling unwell (malaise)
  • Confusion
  • Agitation
  • Delirium
  • Not urinating

 

What Causes Rhabdomyolysis?

Causes of rhabdomyolysis and muscle tissue damage include:

How Is Rhabdomyolysis Diagnosed?

Rhabdomyolysis cannot be diagnosed by a patient history or physical examination alone. Tests used to diagnose rhabdomyolysis include: 

  • Blood tests for creatine kinase (CK or creatine phosphokinase [CPK]), a muscle protein
    • When muscles are damaged, CK levels increase
    • Repeated tests are needed to determine if CK levels are rising or falling
  • Urine dipstick tests to check for myoglobin, a muscle cell component

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What Is the Treatment for Rhabdomyolysis?

Treatment for rhabdomyolysis depends on the cause and severity. The underlying cause of the rhabdomyolysis needs to be treated when possible. Much of the time, hospitalization is needed. 

Treatment for milder cases of rhabdomyolysis may include: 

  • Drinking fluids
  • Getting out of the heat
  • Rest

Treatment for moderate to severe cases of rhabdomyolysis includes:

  • Intravenous (IV) fluids to help the body flush out the substances from muscle cells
  • Medicines to correct salt levels 
  • Treatment to support the kidneys until they can function normally again
    • Medications 
    • Diet changes
    • Renal replacement therapy
      • Hemodialysis: a machine to moves the blood through a filter outside the body to remove waste
      • Peritoneal dialysis: the lining of the abdomen is used to filter the blood inside the body to remove waste
  • Kidney transplant, if kidney function does not recover
  • Emergency surgery to cut open muscles and relieve abnormal build-up of pressure 

What Are Complications of Rhabdomyolysis?

Rhabdomyolysis can lead to serious complications including:

How Do You Prevent Rhabdomyolysis?

Not all cases of rhabdomyolysis can be prevented, but the risk of developing rhabdomyolysis can be reduced by:

  • Staying hydrated
  • Taking breaks 
  • Avoiding activities involving exertion and/or heat exposure when possible 
  • Knowing the signs and symptoms of heat-related illnesses and take steps to prevent overheating
  • Becoming acclimatized to physical activity levels and heat before working for long periods of time
  • Staying home when you’re sick

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Reviewed on 2/25/2021
References
https://www.uptodate.com/contents/rhabdomyolysis-the-basics?search=Rhabdomyolysis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

https://www.cdc.gov/niosh/topics/rhabdo/default.html

https://www.aafp.org/afp/2002/0301/p907.html