Rhabdomyolysis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at October 21, 2016
StartDiseasesRhabdomyolysis

Rhabdomyolysis is a serious medical condition that is caused by the death of muscle fiber in a person's body. Once the muscle is dead, its contents are released into an individual's bloodstream. When this happens, it can result in physical complications such as acute kidney failure.

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Definition & Facts

Rhabdomyolysis results from the breakdown of muscle tissue. A buildup of muscle fiber in a person's body will cause damage. Myoglobin is a protein that part of muscle fiber. It is able to cause damage to the cells within a person's kidneys. Rhabdomyolysis can also result in a person experiencing permanent paralysis.

It is an extremely rare condition affecting approximately 1 in about 10,000 individuals. Rhabdomyolysis was initially identified as a complication from muscle trauma in 1908. At this time, the relationship between muscle trauma and kidney damage was identified in victims of blast injuries from a volcano eruption. It was clarified further with blast victims from World War I and World War II.

Symptoms & Complaints

In many cases, it's difficult to identify when someone has rhabdomyolysis. This condition could vary depending on what is causing it to occur. It's possible for symptoms to happen in one small area of a body or impact the entire body.

Complications could occur during the early as well as later stages of its development. The types of symptoms or complaints a person has will depend on the severity of their case, and if they have experienced kidney failure.

A mild form of rhabdomyolysis may not show any muscle fiber in a person's system. In this case, diagnosis is possible with a blood test. There are a number of different symptoms associated with rhabdomyolysis including the following:

Causes

When a person experiences any type of severe damage to their muscles rhabdomyolysis can result. Possible causes include the following:

  • Exercise. It is possible to develop this condition from extreme physical exercise when not properly hydrated. 
  • Crush syndrome. This is caused by a car accident, physical trauma, injury from an explosion, confinement in a single position for an extended time such as after a stroke. This condition can also result from a prolonged surgery or alcohol intoxication and more.
  • Alcohol withdrawal. This can also occur when a person is trying to stop drinking alcohol and experiences delirium tremens.
  • Medications. There are a number of medications that could cause rhabdomyolysis including fibrates and statins used to treat high cholesterol (hypercholesterolemia); medications that influence a person's potassium level like a diuretic; neuromuscular blocking agents found in certain types of anesthesia; illegal drugs such as cocaine, methamphetamine, LSD, heroin, and others. 
  • It can also be caused by blood clots forming in a person's bloodstream such as an embolism or arterial thrombosis
  • Low calcium, as well as low thyroid function, have also caused this condition. Elevated or decreased blood sodium levels or low potassium levels and more can cause a person to develop rhabdomyolysis. 

Diagnosis & Tests

Testing and diagnosis for rhabdomyolysis will begin with a physician learning about a patient's medical history and conducting a physical examination. The physical examination will be used to detect if a person is experiencing any possible complications resulting from kidney failure. A physician will feel the skeletal muscles in a person's body. They will be checking for tenderness as well as aches.

The next step may be to take blood and urine samples for blood tests and clinical urine tests. One of the goals is to determine levels of potassium. This is an essential mineral that can leak from bone or muscle that has been damaged.

The presence of creatine kinase will also be assessed. This is an enzyme found in a person's heart, skeletal muscles, and brain. Levels of creatinine in a person's urine and blood will be analyzed. This is a product created by muscles in a body. It is usually removed from a person's body by their kidneys. Myoglobin levels in the urine may also be measured. A positive result could confirm the presence of rhabdomyolysis.

Treatment & Therapy

When a person with rhabdomyolysis gets early diagnosis and treatment, their chances of having a successful outcome is very good. Many individuals experience a full recovery. In many cases, a physician will be able to reverse kidney damage if caught early.

When it is determined a patient has rhabdomyolysis, their treatment may begin with intravenous fluids. This will be done to maintain their body's production of urine and prevent kidney failure. Diuretic medications may be administered intravenously. This will help stabilize a person's vital signs such as blood pressure, pulse rate and more.

When the vital signs are stable, mannitol may be given to increase blood flow to a person's kidneys. A solution of sodium bicarbonate may be administered to try and balance the acid-base of a person's urine.

When rhabdomyolysis is a result of a traumatic muscle injury, a patient may be in extreme pain. In this case, a person may be given special narcotic pain medication. In extreme cases, a person may be given a surgical procedure known as a fasciotomy. It is done to decrease the loss of circulation. This will be done to prevent nerve damage as well as muscle death. 

Prevention & Prophylaxis

When a person is taking fibrate and statin medications, they are at an elevated risk for developing rhabdomyolysis. Careful monitoring of how a person's body is responding to the medication could avoid complications.

When someone is involved in an exercise program, they must make certain it is designed to avoid developing rhabdomyolysis. It's important fluid intake be carefully monitored when exercising. Exercising in any extreme temperature whether hot or cold should not be done.

A person should avoid drinking excessive amounts of alcohol right after exercising. Illegal performance-enhancing substances should be avoided to mitigate risk.