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What is Rhabdomyolysis
Rhabdomyolysis is a condition that happens when muscle cells break down and release substances into the blood that can damage the kidneys.
Rhabdomyolysis is a condition characterized by muscle injury leading to myocyte necrosis and the release of intracellular contents into the circulation.
4 Interesting Facts of Rhabdomyolysis
1. Early and vigorous volume resuscitation of patients with rhabdomyolysis (even prior to extrication in crush syndrome) is the key to preventing acute kidney injury (AKI).
2. Serum creatine kinase levels correlate with the degree of muscle injury and help predict the risk of AKI (less common if <10,000 U/L).
3. Blood pressure in rhabdomyolysis is often maintained, even in the setting of large amounts of fluid loss, secondary to vasoconstriction partly due to nitric oxide sequestration by free myoglobin.
4. Life-threatening hyperkalemia may be prominent as a result of the lysis of muscle cells and the release of intracellular potassium.
The term is usually applied when acute kidney injury (AKI) results from the muscle injury, but acute kidney injury does not always occur, even following severe muscle injury.
Rhabdomyolysis is a condition of severe acute muscle injury causing myalgia, muscle weakness, muscle swelling, myoglobinuria, and very elevated CK levels (>5 times upper limit of normal), which develops over hours to days.
Rhabdomyolysis happens because of damage to the muscles that move bones (skeletal muscle). When the skeletal muscles are damaged, substances inside the muscle cells go into the blood. One of these substances is a protein called myoglobin.
Large amounts of myoglobin can cause kidney damage or kidney failure.
Other substances that are released by muscle cells may upset the balance of the minerals (electrolytes) in your blood.
This imbalance causes your blood to have too much acid (acidosis).
What are the causes?
Rhabdomyolysis is caused by muscle damage. Muscle damage often happens because of:
- Using your muscles too much.
- An injury that crushes or squeezes a muscle too tightly.
- Using illegal drugs, mainly cocaine.
- Alcohol abuse.
Other possible causes include:
- Prescription medicines, such as those that:
- Lower cholesterol (statins).
- Treat ADHD (attention deficit hyperactivity disorder) or help with weight loss (amphetamines).
- Treat pain (opiates).
- Infections.
- Muscle diseases that are passed down from parent to child (inherited).
- High fever.
- Heatstroke.
- Not having enough fluids in your body (dehydration).
- Seizures.
- Surgery
- crush injuries
- ischemia
- alcohol/drugs/medications
- metabolic disturbances
- toxic exposures
- infections
- myositis
What increases the risk?
Rhabdomyolysis is more likely to develop in people who:
- Have a family history of muscle disease.
- Take part in extreme sports, such as running in marathons.
- Have diabetes.
- Are older.
- Abuse drugs or alcohol.
What are the symptoms of Rhabdomyolysis?
Symptoms of this condition vary. Some people have very few symptoms, and other people have many symptoms. The most common symptoms include:
- Muscle pain and swelling.
- Weak muscles.
- Dark urine.
- Feeling weak and tired.
Other symptoms include:
- Nausea and vomiting.
- Fever.
- Pain in the abdomen.
- Pain in the joints.
Symptoms of complications from this condition include:
- Heart rhythm that is not normal (arrhythmia).
- Seizures.
- Not urinating enough because of kidney failure.
- Very low blood pressure (shock). Signs of shock include dizziness, blurry vision, and clammy skin.
- Bleeding that is hard to stop or control.
How is Rhabdomyolysis diagnosed?
This condition is diagnosed based on your medical history, your symptoms, and a physical exam. Tests may also be done, including:
- Blood tests.
- Urine tests to check for myoglobin.
You may also have other tests to check for causes of muscle damage and to check for complications.
If either an acquired cause is not clear or there are recurrent episodes, a muscle biopsy in search of metabolic or congenital myopathies or a muscular dystrophy may be indicated.
How is Rhabdomyolysis treated?
Treatment for this condition helps to:
- Make sure you have enough fluids in your body.
- Lower the acid levels in your blood to reverse acidosis.
- Protect your kidneys.
Treatment may include:
- Fluids and medicines given through an IV tube that is inserted into one of your veins.
- Medicines to lower acidosis or to bring back the balance of the minerals in your body.
- Hemodialysis. This treatment uses an artificial kidney machine to filter your blood while you recover. You may have this if other treatments are not helping.
Acute renal failure and its sequelae need to be treated.
Follow these instructions at home:
- Take over-the-counter and prescription medicines only as told by your health care provider.
- Rest at home until your health care provider says that you can return to your normal activities.
- Drink enough fluid to keep your urine clear or pale yellow.
- Do not do activities that take a lot of effort (are strenuous). Ask your health care provider what level of exercise is safe for you.
- Do not abuse drugs or alcohol. If you are having problems with drug or alcohol use, ask your health care provider for help.
- Keep all follow-up visits as told by your health care provider. This is important.
Contact a health care provider if:
- You start having symptoms of this condition after treatment.
Get help right away if:
- You have a seizure.
- You bleed easily or cannot control bleeding.
- You cannot urinate.
- You have chest pain.
- You have trouble breathing.
