Reason for recurrent episodes of rhabdomyolysis
Why do some people develop recurrent episodes of rhabdomyolysis?
Behavioral issues should be explored in patients with recurrent rhabdomyolysis.
Often recurrent episodes of rhabdomyolysis are linked to alcohol and substance abuse.
Toxicology screening can be useful to identify drug or alcohol ingestions as a cause of recurrent muscle injury.
The athlete who is abusing diuretics or laxatives is another example.
In the latter setting, the combination of strenuous exercise with concurrent diuretic- or laxative-induced hypokalemia can lead to muscle injury.
Less frequently, patients with recurrent episodes of rhabdomyolysis have underlying inherited disorders of cell metabolism. These disorders impair cellular energetics as a result of abnormalities in carbohydrate or lipid metabolism.
Usually, patients with inherited metabolic myopathies present in childhood, but adult presentation also occurs.
The most common inherited disorder causing rhabdomyolysis is carnitine palmitoyltransferase deficiency. Often these inherited disorders of metabolism present with a concurrent precipitating factor, such as strenuous exercise or infection.