Kidney and Urologic Diseases

Rhabdomyolysis - Causes, Symptoms, Diagnosis and Treatment

Written by
Dr. Sneha Kannan
and medically reviewed by Dr. Hridyesh Mehra

Published on Feb 21, 2020   -  5 min read

What Is Rhabdomyolysis?

Rhabdomyolysis is a condition that results in the rapid breakdown of skeletal muscle, which results in the leakage of a muscle protein (myoglobin) into the blood and urine. The skeletal muscle helps in the movement of joints. Myoglobin stores oxygen in the muscles. Too much myoglobin in the blood causes kidney damage. Various causes can result in this condition. Rhabdomyolysis results in muscle pain and weakness.

In the US, around 26,000 cases are reported every year. The treatment includes IV fluids and dialysis or hemofiltration if kidney functioning has been affected. Some medications can also result in rhabdomyolysis due to muscle. The levels of muscle enzymes, CPK (creatinine phosphokinase), SGOT (serum glutamic oxaloacetic transaminase), SGPT (serum glutamic pyruvic transaminase), and LDH (lactate dehydrogenase) are elevated in these patients. Severe cases might need hospitalization.

What Causes Rhabdomyolysis?

This condition is triggered by an injury, which can be physical, genetic, or chemical, to the muscles. Any condition or medication that damages the muscles can result in rhabdomyolysis. The following are some of the possible causes:

Injury and Exertion -

  • Crush injury (something heavy falls on a person).

  • Heatstroke.

  • Severe burn injury.

  • Blood vessel blockage.

  • Getting struck by lightning.

  • Severe shivering.

  • An injury that cuts of blood supply to a part of the body (ischemic limb injury).

  • Muscle exertion.

  • Car accident.

  • Running a marathon or intense exercise.

Infections -

  • Bacterial infections.

  • Viral infections.

  • Polymyositis.

  • Snakebites.

  • Dermatomyositis.

Metabolic Conditions -

  • Problems with the metabolism of lipids, fats, carbohydrates, or purines (present in liver, asparagus, fatty fishes).

  • Diabetic ketoacidosis (buildup of ketones).

  • Hypothyroidism (low levels of thyroid hormones).

  • Electrolyte imbalances.

Genetic Conditions -

  • Carnitine deficiency.

  • Duchenne muscular dystrophy.

  • McArdle’s disease.

  • Lactate dehydrogenase deficiency.

Medications -

  • Statins (Atorvastatin, Rosuvastatin, Pravastatin).

  • Cyclosporine.

  • Erythromycin.

  • Colchicine.

  • Amphetamines.

  • Ecstasy.

  • Cocaine.

  • LSD (Lysergic acid diethylamide).

  • Alcoholism.

Toxins -

  • Insect venom.

  • Mold.

  • Carbon monoxide.

What Are the Symptoms of Rhabdomyolysis?

The early symptoms are not specific and often mimic other conditions. Some of the common symptoms include:

  • Muscle weakness.

  • Decreased urine output.

  • Infrequent urination.

  • Fatigue.

  • Bruising.

  • Dark-colored urine (tea-colored).

  • Sore muscles.

  • Fever.

  • Confusion.

  • Agitation.

  • Malaise.

  • Nausea.

  • Vomiting.

How Is Rhabdomyolysis Diagnosed?

Rhabdomyolysis is diagnosed by correlating the history of recent and past events, physical examinations, blood, and urine testing. Your doctor might ask you about any medication use, drug or alcohol abuse, preexisting medical conditions, any recent injury or accident, etc. If your symptoms and history point towards this, then the following tests might be done.

Blood tests, which include complete blood count (CBC), a metabolic panel, muscle enzymes, and urinalysis. The following factors are used to diagnose rhabdomyolysis:

  1. Elevated levels of myoglobin in blood and urine.

  2. Elevated muscle enzymes, such as creatine phosphokinase (CPK), SGOT, SGPT, and LDH, in the blood. These enzymes are the byproducts of muscle destruction. Elevated SGOT and SGPT, without elevated CPK, indicates liver damage.

  3. Potassium will be elevated, as it leaks from injured muscles.

  4. Creatinine might be elevated in the blood and urine.

How Is Rhabdomyolysis Treated?

If detected early, this condition can be successfully treated without any permanent damage to the liver and kidneys. The treatment options include:

  • Fluid Replacement - It is crucial for the body to get enough fluids. For this, IV fluids should be started immediately. The bicarbonate in the fluid helps flush the protein myoglobin from the kidneys.

  • Medications -

    • Bicarbonate and some diuretics are prescribed to help the proper functioning of the kidneys.

    • IV fluids - To treat high levels of potassium (hyperkalemia) and low levels of calcium (hypocalcemia), appropriate IV fluids are administered.

  • Dialysis - In severe cases, where the kidney and liver damage have already begun, then dialysis is done. Here, the patient’s blood is taken out of the body, so that it can be cleaned in a dialysis unit, which helps remove waste products. Then purified blood is transferred back to the body.

Home Remedies:

If the patient is not exhibiting severe symptoms, home remedies can help with recovery. The goal is to rest the body so that the muscles rehydrate and recover, which will prevent further organ damage. Some home remedies include:

  • Identifying the cause, for example medicines, and discontinue them after talking to your doctor.

  • Relax and sit in a comfortable position when you feel fatigued.

  • Keep drinking water and other fluids to flush out myoglobin from the body.

  • Sip on herbal teas or clear soups.

What Are the Possible Complications of Rhabdomyolysis?

The following are the possible complications of rhabdomyolysis:

  1. Kidney failure - It is one of the most dreaded complications. The causes include direct kidney injury or clogging of the kidney’s filtering tubes by the muscle proteins (myoglobin). This impairs kidney function and can also result in kidney failure.

  2. Compartment syndrome - It is another serious complication, where a confined space becomes swollen, which increases the pressure in that space. This results in reduced blood flow, which can result in tissue necrosis. This complication is commonly seen after an injury to the body’s extremities.

  3. Electrolyte imbalance - Muscle injury results in the breakdown of muscles, which causes the levels of potassium and phosphorus in the blood to rise. Hyperkalemia and hyperphosphatemia can lead to electrolyte imbalance in the body.

Prognosis:

As long as this condition is detected and treated early, the prognosis or treatment outcome is good. Most cases of rhabdomyolysis are reversible. But in severe cases, kidney damage and electrolyte imbalance will need hospitalization and regular dialysis.

To prevent rhabdomyolysis, make sure you drink enough water before and after running a marathon or strenuous exercise. If you have been diagnosed with this condition, take rest and keep yourself hydrated. Always drink water as soon as you feel a little thirsty, and avoid waiting till your mouth and throat are completely dry. If you are suffering from an infection, then make sure you consult a doctor and take antibiotics, as infections can also cause rhabdomyolysis. In case you have a degenerative muscle condition, go for regular checkups.

For more information on rhabdomyolysis, consult a doctor online now!

 

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Last reviewed at:
21 Feb 2020  -  5 min read

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