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Rhabdomyolysis

Rhabdomyolysis
A container half-full with brown-stained urine, characteristic for rhabdomyolysis
Urine from a person with rhabdomyolysis showing the characteristic brown discoloration as a result of myoglobinuria
Pronunciation
SpecialtyCritical care medicine, nephrology
SymptomsMuscle pains, weakness, vomiting, confusion, tea-colored urine, irregular heartbeat[3][4]
ComplicationsKidney failure, high blood potassium, low blood calcium, disseminated intravascular coagulation, compartment syndrome[3]
CausesCrush injury, strenuous exercise, medications, substance use, certain infections[3]
Diagnostic methodBlood test (creatine kinase), urine test strip[3][5]
TreatmentIntravenous fluids, dialysis, hemofiltration[3]
Frequency26,000 reported cases per year (U.S.)[3]

Rhabdomyolysis (shortened as rhabdo) is a condition in which damaged skeletal muscle breaks down rapidly, often due to high intensity exercise over a short period of time.[6][4][5] Symptoms may include muscle pains, weakness, vomiting, and confusion.[3][4] There may be tea-colored urine or an irregular heartbeat.[3][5] Some of the muscle breakdown products, such as the protein myoglobin, are harmful to the kidneys and can cause acute kidney injury.[7][3]

The muscle damage is most usually caused by a crush injury, strenuous exercise, medications, or a substance use disorder.[3] Other causes include infections, electrical injury, heat stroke, prolonged immobilization, lack of blood flow to a limb, or snake bites[3] as well as intense or prolonged exercise, particularly in hot conditions.[8] Statins (prescription drugs to lower cholesterol) are considered a small risk.[9] Some people have inherited muscle conditions that increase the risk of rhabdomyolysis.[3] The diagnosis is supported by a urine test strip which is positive for "blood" but the urine contains no red blood cells when examined with a microscope.[3] Blood tests show a creatine kinase activity greater than 1,000 U/L, with severe disease being above 5,000-15,000 U/L.[5]

The mainstay of treatment is large quantities of intravenous fluids.[3] Other treatments may include dialysis or hemofiltration in more severe cases.[4][10] Once urine output is established, sodium bicarbonate and mannitol are commonly used but they are poorly supported by the evidence.[3][4] Outcomes are generally good if treated early.[3] Complications may include high blood potassium, low blood calcium, disseminated intravascular coagulation, and compartment syndrome.[3]

Rhabdomyolysis is reported about 26,000 times a year in the United States.[3] While the condition has been commented on throughout history, the first modern description was following an earthquake in 1908.[11] Important discoveries as to its mechanism were made during the Blitz of London in 1941.[11] It is a significant problem for those injured in earthquakes, and relief efforts for such disasters often include medical teams equipped to treat survivors with rhabdomyolysis.[11]

  1. ^ "Rhabdomyolysis". Merriam-Webster.com Dictionary.
  2. ^ "Rhabdomyolysis". Dictionary.com Unabridged (Online). n.d.
  3. ^ a b c d e f g h i j k l m n o p q r Sauret JM, Marinides G, Wang GK (March 2002). "Rhabdomyolysis". American Family Physician. 65 (5): 907–912. PMID 11898964.
  4. ^ a b c d e Huerta-Alardín AL, Varon J, Marik PE (April 2005). "Bench-to-bedside review: Rhabdomyolysis -- an overview for clinicians". Critical Care. 9 (2): 158–169. doi:10.1186/cc2978. PMC 1175909. PMID 15774072.
  5. ^ a b c d Chavez LO, Leon M, Einav S, Varon J (June 2016). "Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice". Critical Care. 20 (1): 135. doi:10.1186/s13054-016-1314-5. PMC 4908773. PMID 27301374.
  6. ^ "What is Rhabdo? | NIOSH | CDC". www.cdc.gov. 3 December 2021. Retrieved 15 December 2022.
  7. ^ Kodadek L, Carmichael Ii SP, Seshadri A, Pathak A, Hoth J, Appelbaum R, Michetti CP, Gonzalez RP (2022). "Rhabdomyolysis: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document". Trauma Surg Acute Care Open. 7 (1): e000836. doi:10.1136/tsaco-2021-000836. PMC 8804685. PMID 35136842.
  8. ^ Oh RC, Bury DC, McClure CJ (November 2022). "Exertional rhabdomyolysis: an analysis of 321 hospitalised US military service members and its relationship with heat illness". BMJ Military Health: e002028. doi:10.1136/military-2021-002028. PMID 36442890. S2CID 254067955. Retrieved 6 July 2023.
  9. ^ Cite error: The named reference Sathasivam was invoked but never defined (see the help page).
  10. ^ Bosch X, Poch E, Grau JM (July 2009). "Rhabdomyolysis and acute kidney injury". The New England Journal of Medicine. 361 (1): 62–72. doi:10.1056/NEJMra0801327. PMID 19571284. S2CID 4652812.
  11. ^ a b c Vanholder R, Sever MS, Erek E, Lameire N (August 2000). "Rhabdomyolysis". Journal of the American Society of Nephrology. 11 (8): 1553–1561. doi:10.1681/ASN.V1181553. PMID 10906171.

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