Rhabdomyolysis is the breakdown of damaged skeletal muscle.
Muscle breakdown causes the release of myoglobin into the bloodstream.
Myoglobin is the protein that stores oxygen in your muscles. If you have too
much myoglobin in your blood, it can cause kidney damage.
About 26,000 cases
of rhabdomyolysis are reported in the United States each year. Most people with
rhabdomyolysis are treated with fluids given through their veins in an
intravenous (IV) drip. Some people may require dialysis or hemofiltration to
address kidney damage in more severe cases.
Recognizing the symptoms
The initial symptoms of rhabdomyolysis can be subtle. They’re not specific
and may mimic other conditions. The symptoms of rhabdomyolysis include:
- muscle weakness
- low urine output
- dark, tea-colored urine
- infrequent urination
- a fever
- a sense of malaise, or feeling sick
What causes rhabdomyolysis?
Rhabdomyolysis is always triggered by muscle injury. This injury can have
physical, chemical or genetic causes. Anything that damages the muscles can
cause this condition. Possible causes include the following:
heat, and exertion
Causes in this category include:
- a crush injury, which can occur when something heavy
falls on you
- a heatstroke
- a third-degree burn
- blocked blood vessels
- a lightning strike
- intense shivering
- an ischemic limb injury, which occurs when your tissue
lacks an adequate blood supply
- pathological muscle exertion
exercise, such as marathon running
and metabolic disorders
Some people develop rhabdomyolysis because of genetic
conditions such as problems with metabolism of
- lipids, or fats
- purines, which are in certain foods, such as
sardines, liver, asparagus
Metabolic problems, such as the following, can also trigger
- hypothyroidism or low thyroid hormone levels
- diabetic ketoacidosis, or a buildup of ketones
in the body
- electrolyte imbalances
Genetic disorders that can lead to rhabdomyolysis include:
- a carnitine deficiency
- McArdle’s disease
- a lactate dehydrogenase deficiency
- Duchenne muscular dystrophy
Many types of infection and inflammation can cause rhabdomyolysis,
- viral infections
- bacterial infections
One important cause of rhabdomyolysis is statin medications, which are
cholesterol-lowering drugs that many people take. Statins include:
Although rhabdomyolysis only occurs in a few people who take statins, so
many people take these medications that it’s important to be aware of the risk.
The condition can also occur due to exposure to other drugs, certain toxins,
and high levels of alcohol. Other drugs that can cause rhabdomyolysis include:
Many other potential causes exist in these four categories beyond the ones
How is rhabdomyolysis diagnosed?
Your doctor will look and feel the larger skeletal muscles in your body,
especially any that ache, to check for tenderness. They may also perform urine
and blood tests to confirm a diagnosis of rhabdomyolysis.
Tests to determine muscle and kidney health may include determining levels
- creatine kinase, which is an enzyme found in the
skeletal muscles, the brain, and the heart
- myoglobin in blood and urine, which is a protein that’s
a byproduct of muscle breakdown
- potassium, which is another important mineral that may
leak from injured bone and muscles
- creatinine in blood and urine, which is a breakdown product
created by muscle that’s normally removed from the body by the kidneys
levels of these substances are signs of muscle damage.
Treatments options for rhabdomyolysis
If discovered early in its progression, rhabdomyolysis can be successfully
treated without long-term damage to the kidneys.
Getting enough fluid into your body is the first and most important
treatment. They must start IV fluids quickly. This fluid should contain
bicarbonate, which helps flush the myoglobin out of your kidneys.
Your doctor may prescribe medications such as bicarbonate and certain kinds
of diuretics to help keep your kidneys functioning.
They can also treat high potassium levels in the blood, or hyperkalemia, and
low blood calcium levels, or hypocalcemia, with appropriate IV fluids.
If kidney damage and acute renal failure have already started, you may need
to receive dialysis. During dialysis, blood is taken out of the body and
cleaned in a special machine in order to remove waste products.
In mild cases of rhabdomyolysis, home treatment can help aid
in the recovery process. The goals of at-home treatment include resting the
body so muscles can recover and rehydration to help prevent further kidney
When you’re feeling fatigued, recline in a comfortable
position and try to relax. Drink plenty of water and other clear liquids, such
as light broth and sports drinks.
Your long-term outlook depends on the degree of kidney damage. If
rhabdomyolysis is caught early, you may be able to avoid major complications
and return to normal health in a few weeks. Even then, however, you may still
have some lingering weakness and pain in your muscles.
If major kidney damage occurs, your kidneys may be permanently damaged.
Several of the symptoms and complications of rhabdomyolysis are serious and
may result in death if you don’t get treatment for them.
Tips for preventing rhabdomyolysis
You can prevent rhabdomyolysis by drinking plenty of fluids
before and after strenuous exercise. This will dilute your urine and help your
kidneys eliminate any myoglobin that your muscles may have released during
If you have an existing degenerative muscle condition or
have sustained damage to your muscle after a recent trauma, you can prevent
rhabdomyolysis by staying well-hydrated at all times. Carry a full refillable
water bottle with you at all times so you can make sure you’ll have access to
something to drink. Drink whenever you begin to feel thirsty, and don’t wait
until your thirst increases.
See your doctor when you suspect you may be sick or have an
infection. Addressing illness as soon as possible can help prevent the muscle
damage that may lead to rhabdomyolysis.