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Rhabdomyolysis - Causes, Symptoms, Diagnosis and Treatment

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Rhabdomyolysis - Causes, Symptoms, Diagnosis and Treatment

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Rhabdomyolysis is the destruction of muscle tissue that causes the contents of muscle fibers to be released into the circulation. Read on to know more.

Medically reviewed by

Dr. Hridyesh Mehra

Published At February 21, 2020
Reviewed AtMarch 28, 2024

What Is Rhabdomyolysis?

Rhabdomyolysis is a disorder in which skeletal muscle is rapidly broken down, resulting in the leakage of a muscle protein (myoglobin) into the blood and urine. Skeletal muscle facilitates joint mobility. In muscles, myoglobin stores oxygen. Kidney injury results from an excess of myoglobin in the blood. This illness can have several reasons. Rhabdomyolysis causes weakness and discomfort in the muscles.

Approximately 26,000 cases are recorded annually in the US. Intravenous fluids and, if renal function is compromised, dialysis or hemofiltration are part of the treatment. Muscle-related rhabdomyolysis can also be brought on by some drugs. These patients have increased levels of muscle enzymes, including lactate dehydrogenase (LDH), SGOT (serum glutamic oxaloacetic transaminase), SGPT (serum glutamic pyruvic transaminase), and CPK (creatinine phosphokinase). Serious instances may require hospitalization.

What Causes Rhabdomyolysis?

An injury to the muscles, whether it be chemical, hereditary, or physical, causes this disorder. Rhabdomyolysis may arise from any medical condition or drug that causes injury to the muscles. Listed below are a few potential reasons:

Injury and Exertion -

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

  • Heatstroke.

  • Severe burn damage.

  • Obstruction of blood vessels.

  • Being struck by lightning.

  • Extreme shivering.

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

  • Muscle strain.

  • Vehicle mishap.

  • Marathon running or strenuous activity.

Infections -

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).

  • Imbalances in electrolytes.

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.

Does Rhabdomyolysis Inherit?

Rhabdomyolysis cannot be inherited. There are several hereditary disorders that can make one more susceptible to getting the condition. If individuals have muscular dystrophy or another hereditary muscle disorder, they may get rhabdomyolysis.

What Are the Symptoms of Rhabdomyolysis?

The early symptoms are not specific and often mimic other conditions. The "classic triad" of symptoms associated with rhabdomyolysis includes discomfort in the shoulders, thighs, or lower back; weakness or swelling in the muscles or difficulty moving both arms and legs; and deep red or brown urine or reduced urination.

Some of the common symptoms include:

  • Muscle weakness.

  • Infrequent urination.

  • Fatigue.

  • Bruising.

  • Sore muscles.

  • Fever.

  • Confusion.

  • Agitation.

  • Malaise.

  • Nausea.

  • Vomiting.

  • Swelling of muscles.

Which Variables Put One at Risk for Rhabdomyolysis?

Anyone can develop rhabdomyolysis. Nonetheless, the following conditions may increase the likelihood of rhabdomyolysis:

  • An Athlete: Rhabdomyolysis is more common in marathon runners, spin instructors, and other participants in high-intensity interval training. This condition is not brought on by infrequent endurance exercises. Pushing oneself too hard without taking a break raises the danger.

  • Working in Hot Conditions: This condition can be developed by those who perform intense physical labor in hot environments, such as firefighters and foundry workers. Rhabdomyolysis can be brought on by or made more likely by overheating.

  • Over 65: If people are older than 65, they may be more vulnerable to falling and becoming incapacitated. Prolonged inactivity can result in rhabdomyolysis.

How Is Rhabdomyolysis Diagnosed?

The history of recent and historical events, physical examinations, blood, and urine tests are all used to identify rhabdomyolysis. A doctor may inquire about drug or alcohol addiction, medication use, prior medical issues, recent injuries or accidents, etc. If the medical history and symptoms suggest this, one may have the following tests.

Blood tests include a complete blood count (CBC), a metabolic panel, muscle enzymes, and urinalysis. The diagnosis of rhabdomyolysis is based on the following factors:

  1. Increased myoglobin levels in the urine and blood.

  2. Increased blood levels of muscle enzymes, including LDH, SGOT, SGPT, and creatine phosphokinase (CPK). These enzymes are the leftovers from the breakdown of muscle. Liver injury is indicated by high SGOT and SGPT but not elevated CPK.

  3. Due to leakage from injured muscles, potassium levels will rise.

  4. There may be an increase in creatinine in the urine and blood.

How Is Rhabdomyolysis Treated?

If diagnosed early, this illness can be successfully treated without causing irreversible liver and kidney damage. Among the available treatments are:

  • Fluid Replacement - The body must get enough fluids. IV (intravenous) fluids should be begun right away for this. The fluid's bicarbonate aids in the kidneys' removal of the protein myoglobin.

  • Medications -

    • To support the kidneys' healthy operation, prescriptions for bicarbonate and some diuretics are given.

    • IV fluids - Appropriate IV fluids are given to treat hypocalcemia (low calcium levels) and hyperkalemia (high potassium levels).

  • Dialysis - Dialysis is used in extreme situations where kidney and liver damage has already started. This involves drawing the patient's blood out of the body for cleaning in a dialysis machine, which aids in the removal of waste. The body then receives the cleansed blood.

Home Remedies:

Home remedies can aid in recuperation if the patient's symptoms are not severe. The body should be rested in order to allow the muscles to heal and rehydrate, thereby halting additional organ damage. Among the natural cures are:

  • Determine the cause, such as medications, and stop taking them after consulting your physician.

  • When fatigued, sit back and find a comfortable position.

  • Continue consuming liquids, such as water, to help the body eliminate myoglobin.

  • Drink clear soups or herbal teas.

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 kidneys can be directly injured, or the muscle proteins (myoglobin) can clog the kidney's filtering tubes. Kidney failure may potentially follow from this, which damages renal function.

  2. Compartment Syndrome -Another dangerous consequence is when a small area swells and the pressure inside that area rises. Due to the decreased blood supply that follows, tissue necrosis may occur. This complication frequently occurs following an injury to one of the body's extremities.

  3. Electrolyte Imbalance - When muscles are injured, they break down, which raises the blood levels of phosphorus and potassium. An electrolyte imbalance within the body can result from both hyperphosphatemia and hyperkalemia.

What Is the Prognosis of Rhabdomyolysis?

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

Conclusion:

Without therapy, rhabdomyolysis is a dangerous disorder that can be fatal. See a healthcare professional if one observes any indications or symptoms of the illness. By paying attention to the body during exercise, one can lower the chance of getting this illness. Take a break if feeling exhausted. An early diagnosis and course of treatment will improve the likelihood of recovery.

Frequently Asked Questions

1.

What Is the Most Common Cause of Rhabdomyolysis?

Rhabdomyolysis is a severe life-threatening syndrome. This condition usually occurs due to a breakdown of skeletal muscle fibers in the body, leading to the leakage of muscle contents into the blood circulation. The most common causes of rhabdomyolysis are crush injury from a road traffic accident, excessive physical activities more than the skeletal muscles’ capability, alcohol abuse, and certain other medicines and toxic substances.

2.

Can Rhabdomyolysis Be Treated?

Yes, rhabdomyolysis can be treated. Most of the affected people with rhabdomyolysis are being treated with the help of fluids given through their veins as an intravenous (IV) drip. Some patients with severe rhabdomyolysis might even require dialysis or hemofiltration to address kidney damage in people.

3.

How Long Can My Rhabdomyolysis Last?

The primary factor that decides the time period of rhabdomyolysis is the degree of kidney damage. If people in whom rhabdomyolysis has been diagnosed early, he or she may be able to avoid several major complications and return to their normal routine activities in a very few weeks. However, once a person is affected by rhabdomyolysis, they might still have certain lingering weakness and pain in their muscles even after getting cured.

4.

What Is the Best Cure for Rhabdomyolysis?

The primary goal of treatment is to address the ongoing kidney damage caused due to rhabdomyolysis and avoid the incidence of unnecessary life-threatening complications. The following is the list of medicines and their brand names which are noted to provide the best cure for rhabdomyolysis:
- Atorvastatin (Lipitor).
- Rosuvastatin (Crestor).
- Pravastatin (Pravachol).

5.

How Painful Can Rhabdomyolysis Be?

Unlike other conditions that affect the skeletal muscle, rhabdomyolysis causes extreme pain where the skeletal muscles become very stiff and rigid. The muscles become so rigid that it could be so hard for the affected individual even to move. At the hospital, the affected patients with rhabdomyolysis describe the pain as an excruciating one. The pain is not similar to the pain that is caused by normal workouts.

6.

How Do the Symptoms of Rhabdomyolysis Feel Like?

The “classic triad” of rhabdomyolysis symptoms are as follows:
- Muscle pain in the shoulders, thighs, or lower back.
- Muscle weakness with associated trouble in moving arms and legs.
- Passage of dark red or brown urine or decreased urination.

7.

Can Dehydration Be a Cause of Rhabdomyolysis?

Yes, dehydration and severe overheating are one of the chief causes of rhabdomyolysis. The reason behind this is that heat can cause a faster breakdown of muscles when compared to normal. The other causes of rhabdomyolysis are as following:
- High-intensity physical exercises.
- Starting a difficult exercise program too fast can lead to the development of rhabdomyolysis. This is because, in this situation, the skeletal muscles will not have adequate time to heal after an intense workout.

8.

How Fast Can Rhabdomyolysis Start to Develop in a Person?

Rhabdomyolysis symptoms in an affected individual can usually develop in a period of one to three days after the muscle injury has happened. However, some affected people may not even experience muscle soreness. The initial and persisting sign of rhabdomyolysis is noted to be muscle swelling.

9.

What Are the Beverages That Can Be Drunk for Rhabdomyolysis?

All types of healthy fluids, such as fruit juices, can be drunk for rhabdomyolysis. The affected individuals are usually advised to drink an increased quantity of liquids if they are doing strenuous work, exercise, and if the environment is warm outside. The reason behind this is that liquids can help in flushing out substances from the body. It is also important to note that certain beverages such as alcohol and caffeine should be avoided because they can increase the risk of rhabdomyolysis.

10.

When Should I Go to the Doctor for Rhabdomyolysis?

Rhabdomyolysis is a very important medical emergency that requires immediate medical attention. If you have any of the following symptoms, you are advised to immediately rush to the emergency room.
- Passage of dark, brownish, or pinkish-red urine.
- Unusually stiff, painful, or tender muscles.
- The sudden and steady development of muscle swelling.

11.

What Is the Most Common Serious Complication of Rhabdomyolysis?

The most common and serious complication of rhabdomyolysis is noted to be an acute renal failure. This complication is noted to occur in approximately 15 percent of patients with this condition. Early diagnosis of the condition and prompt medical management of complications is very crucial to bring out a successful outcome.

12.

How Can I Stop My Rhabdomyolysis?

The following is a list of certain tips and precautions to prevent and stop rhabdomyolysis.
- You can prevent the occurrence of rhabdomyolysis by drinking plenty of fluids before and after a strenuous workout session. This will help dilute your urine and help your kidneys eliminate any myoglobin that your muscles might have released during exercise.
- Always do a difficult category of workouts with proper expert guidance.
- Do not do a difficult workout as a beginner. Do it step by step from the easiest ones to the difficult ones.

13.

Can a Person Have Mild Rhabdomyolysis?

Yes, some people might have mild rhabdomyolysis. Some symptoms of rhabdomyolysis are muscle swelling, weakness, and tenderness of the affected muscles. However, mild cases may not experience any symptoms.

14.

Can Rhabdomyolysis Be Treated at Home?

Yes, for people affected only with a mild type of rhabdomyolysis, home treatment can help very well and aid in the recovery process. The aim of at-home treatment of rhabdomyolysis includes:
- The affected person should rest so that muscles can recover.
- Rehydration to help prevent further kidney damage.
- Pain medications as per doctor's advice.

15.

What Are the Signs of Rhabdomyolysis?

The following are the signs that can make the doctor highly suspective of rhabdomyolysis.
- Muscle pains.
- Weakness.
- Vomiting.
- Confusion.
- Tea-colored urine.
- Irregular heartbeat.

16.

How Long Can Rhabdomyolysis Take to Go Away?

If the condition is diagnosed and treated early, you can avoid many significant complications and expect a complete recovery in a few weeks. Recovery from rhabdomyolysis due to exercise, with no major complications, can take a period of about several weeks to months for the patient to return to their routine without recurrence of symptoms.
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Dr. Hridyesh Mehra
Dr. Hridyesh Mehra

General Practitioner

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