Rhabdomyolysis is a potentially very serious syndrome caused by the injury to and the destruction of the body’s skeletal muscles. When muscle fibers are destroyed, they leak their breakdown products such as myoglobin into your bloodstream.
When this happens it can then result in further complications such as kidney failure. Renal failure occurs if the kidneys are unable to remove concentrated urine and other waste from the system. In very rare and severe cases, rhabdomyolysis can even lead to death but as long treatment is carried out promptly, the prognosis is usually positive.
Causes of Rhabdomyolisis
The syndrome can occur as a result of many causes but basically any type of sufficiently severe muscle damage may cause rhabdomyolysis. It is a significant problem for people trapped under buildings following an earthquake or building collapse as well as people crushed in a car accident.
However, there are more common causes such as strenuous exercise and certain medications that people should be aware of.
- Using illegal drugs including cocaine, heroin and amphetamines.
- Heavy alcohol consumption.
- Severe crush injuries from car accidents, falls or the collapse of a building.
- Extreme muscular strain especially in untrained athletes although elite athletes are still at risk. The risk is greater when the athlete is not sufficiently hydrated.
- Certain medications can cause rhabdomyolysis including statins and fibrates (taken for high cholesterol), antipsychotics and medications that disrupt potassium levels like diuretics.
- Very high or very low body temperatures can cause the syndrome.
- Electric shock or lightning strike.
- Bacterial infections which lead to toxins pooling in the tissues or sepsis.
- Muscle diseases like muscular dystrophy.
- Viral infections like HIV, herpes simplex or influenza.
- Certain metabolic disorders like ketoacidosis and hypothyroidism.
The symptoms associated with rhabdomyolysis are not always easy for doctors to pinpoint in order to make a proper diagnosis. The reason for this is that the symptoms vary according to the severity of the condition coupled with the fact that the course of the condition will vary depending on the many potential causes.
Symptoms may present themselves in just one area or affect the entire body and they may occur at different stages following the muscle damage.
Milder forms of rhabdomyolysis might cause no muscle symptoms in which case diagnosis is usually based on blood test abnormalities. In more severe cases of rhabdomyolysis, the condition is likely to be characterized by severe muscle pain and weakness as well as swelling and tenderness of the muscles.
When the swelling is rapid as may be the case when a person is released from a car accident or beneath a building, the rapid movement of the fluid into the damaged muscles from the bloodstream might cause a reduction in blood pressure and then shock.
Some of the most common symptoms and indicators of rhabdomyolysis are listed below:
- Muscle pain which can occur anywhere in the body but especially to the large muscle groups in the thighs, lower back and shoulders.
- Muscle weakness and trouble moving the limbs.
- Swollen muscles
- Abdominal pain
- Nausea and vomiting
- Rapid heartbeat
- Mental confusion
- Dark brown or dark red colored urine or no urination.
Blood tests and urine tests can help doctors to properly diagnose rhabdomyolysis. The blood test is for a protein called creatine kinase which is released when the muscles are severely damaged. Urine tests will look for levels of myoglobin, a protein related to hemoglobin which is also released as a result of muscle damage. Other tests might be conducted to confirm the syndrome and to rule out further complications.
Common Complications of Rhabdomyolysis
As many as half of all people with rhabdomyolysis experience kidney failure. There are many reasons why kidney failure may occur. The kidney’s filtering tubes may become plugged by the proteins released by the muscles and unable to eliminate waste. Elevated levels of potassium can also cause kidney damage as can direct injury to the organs themselves.
Another complication is a condition known as compartment syndrome. This condition is based on clinical diagnosis as there are no conclusive diagnostic tests. It is diagnosed by measuring the difference between pressure in one of the fascial compartments and blood pressure.
When compartment pressure is high and there is little difference with blood pressure, it indicates a lack of blood supply which may require surgical intervention.
Rhabdomyolysis may also cause abnormalities to the electrolytes in your blood. When the muscles are badly injured or damaged, the contents of their cells might leak into the bloodstream causing elevated potassium and phosphorus levels.
Highly elevated potassium levels in the bloodstream can cause an irregular or rapid heartbeat or even cardiac arrest. When potassium levels are elevated, one of the most common complications is kidney damage seen in around half the patients.
Treatment for Rhabdomyolisis
First of all, it is important to point out that an early diagnosis is key to a successful recovery. Kidney damage is reversible but compartment syndrome might cause long term damage if it is not dealt with swiftly enough.
Once rhabdomyolysis is diagnosed, the hospital will admit you in order to identify the cause and treat the cause of the condition. This may include discontinuing certain medications, replacing your body’s electrolytes or treating any underlying muscle condition.
In very mild cases of rhabdomyolysis where the patient is not at risk of complications, it may be possible to manage the condition at home simply by rehydrating the body well and discontinuing any medications that caused the syndrome.
If the rhabdomyolysis is more severe, home treatment will not be an option and you will probably be admitted for treatment at the hospital. Prompt hydration by intravenous fluid treatment helps to maintain the production of urine and prevent further complications like kidney failure.
Your electrolyte levels will be monitored to protect against heart and organ failure as will your muscle enzymes.
In some cases, dialysis may be necessary to help the kidneys filter out waste products as they recover. If a person has compartment syndrome then a surgical procedure called a fasciotomy may be required to relieve the pressure and stimulate blood flow.
Where rhabdomyolysis is caused by an underlying medical condition such as hyperthyroidism or diabetes, the hospital will have to treat the underlying condition. If the syndrome is known to be caused by medications like statins, the medications will be discontinued and possibly replaced.
So long as the condition is recognized quickly enough and treated in time, the prognosis is generally very good and the majority of people will make a full recovery.
With prompt treatment being so important, I though t it would be useful to attach a final word of warning. The internet is full of stories where people went to the emergency room suspecting they had rhabdomyolysis but were ignored by the doctors. In the case of amateur athletes, the muscle pain was often attributed to normal muscle soreness after working out.
Of course, it is highly likely that muscle pain is no more than the usual wear and tear but if f you are genuinely concerned about the severity of the pain and it is accompanied by any other symptoms, you may have to be proactive in directing your doctors.