Rhabdomyolysis refers to the breakdown of muscle tissue that results in the release of a protein called myoglobin into the bloodstream, which when broken down further is harmful to the kidneys and may cause kidney damage.
Rhabdomyolysis causes include trauma or injury or any other condition that damages muscles, including:
- The use of recreational drugs like cocaine, heroin and amphetamines
- Extremes in body temperature
- Extreme physical exertion, for example marathon running (this is known as exertional rhabdomyolysis)
- Low phosphate levels
- Ischaemia (a vascular disease where there is a reduction in the arterial blood supply to tissues, organs or extremities)
- Certain medications
- Long-lasting muscle compression from prolonged immobilsation
- Severe dehydration
Rhabdomyolysis is a serious syndrome that requires prompt treatment. It can lead to a complication called compartment syndrome (the compression of nerves, blood vessels and muscles), which may result in muscle death or nerve damage.
What are its symptoms?
Rhabdomyolysis symptoms include the following:
- Muscle weakness
- Muscle pain, especially in the shoulders, thighs and lower back
- Dark-coloured urine
- Fever
- Rapid heart rate
- Confusion
- Dehydration
How is it diagnosed?
A rhabdomyolysis diagnosis usually involves blood tests to check for the presence of creatine kinase, a product of muscle breakdown, and urine tests to check for myoglobin, which is released from muscle that is damaged.
Complications from the condition include very high levels of potassium in the blood that may lead to irregular heartbeat and kidney and liver damage, so blood potassium levels will also be tested.
What are your treatment options?
The cause of the rhabdomyolysis needs to be established so that comprehensive treatment can be administered.
Rhabdomyolysis treatment involves hospitalisation and begins with intravenous fluids to help maintain optimal urine output (200-300ml per hour) and prevent kidney (renal) failure.
It also involves managing any electrolyte imbalances, in particular potassium, calcium and phosphorus, to help protect the heart and other organs.
If compartment syndrome (the compression of nerves, blood vessels and muscles), a complication of this condition, occurs, a surgical procedure known as a fasciotomy may be performed to relieve pressure and restore circulation.
In some case close monitoring in the intensive care unit may be necessary.
Can it be prevented?
The following measures can reduce the risk factors associated with rhabdomyolysis:
- Increase fluid intake after any procedure that may damage muscles and during periods of immobilsation
- Be aware of the side effects and risks of any medication you’re on, for example, statin and fibrate medication sometimes prescribed for high cholesterol. Patients taking this medication should be on the alert of signs and symptoms of rhabdomyolysis
When training or doing strenuous exercise, the following is advised:
- Hydrate before, during and afterwards, preferably with electrolytes
- Muscles need energy to perform, so carbo-loading before big events is essential
- Avoid training in extreme heat
- Don’t undertake extreme physical activity; gradual exposure is advised
- Increase your fluid intake after doing strenuous exercise – this helps dilute the urine
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