Rhabdomyolysis: Causes, Symptoms and Treatment

What is rhabdomyolysis?

It is a serious syndrome due to a direct or indirect muscle injury. It is the result of the death of muscle fibers and the release of their contents in the bloodstream.

This can lead to serious complications such as kidney (kidney) failure. This means that the kidneys can not eliminate waste and concentrated urine. In rare cases, rhabdomyolysis can even cause death.

However, quick treatment often brings a good result. This is what you need to know about rhabdomyolysis.

Causes

There are many traumatic and non-traumatic causes of rhabdomyolysis. In the first category, the causes include:

  • A crush injury such as from a car accident, fall, or collapse of a building
  • Long-term muscle compression, such as that caused by prolonged immobilization after a fall or lying unconscious on a hard surface during illness or while under the influence of alcohol or medication
  • Injuries from electric shock, lightning or third-degree burns
  • Poison from a snake or insect bite

The nontraumatic causes of rhabdomyolysis include:

  • The use of alcohol or illegal drugs such as heroin, cocaine or amphetamines
  • Extreme muscle tension, especially in someone who is an inexperienced athlete; This can also happen in elite athletes, and it can be more dangerous if there is more muscle mass to break.
  • The use of medications such as antipsychotics or statins, especially when administered in high doses
  • A very high body temperature (hyperthermia) or heat stroke
  • Convulsions or delusions
  • A metabolic disorder such as diabetic ketoacidosis
  • Muscle diseases (myopathy) such as congenital muscular enzyme deficiency or Duchenne muscular dystrophy
  • Viral infections such as influenza, HIV or herpes simplex virus
  • Bacterial infections that lead to toxins in the tissues or the bloodstream (sepsis)
  • A previous history of rhabdomyolysis also increases the risk of having rhabdomyolysis again.

Signs and symptoms of Rhabdomyolysis

The signs and symptoms of rhabdomyolysis can be difficult to identify. This is largely true because the course of rhabdomyolysis varies, depending on its cause. And, symptoms can occur in one area of ​​the body or affect the entire body. In addition, complications can occur in the early and later stages.

The “classic triad” of the symptoms of rhabdomyolysis are: muscle pain in the shoulders, thighs or lower back; muscle weakness or difficulty moving arms and legs; and dark red or brown urine or decreased urination.

Keep in mind that half of people with the condition may not have any muscle symptoms.

Other common signs of rhabdomyolysis include:

  • Abdominal pain
  • Nausea or vomiting
  • Fever, rapid heart rate
  • Confusion, dehydration, fever or lack of consciousness

Blood tests for creatine kinase, a product of muscle breakdown, and urine tests for myoglobin, a relative of hemoglobin that is released from damaged muscles, can help diagnose rhabdomyolysis (although in the middle of people with the condition, the myoglobin test can get to negative).

Other tests can rule out other problems, confirm the cause of rhabdomyolysis or detect complications.

The most common complications of rhabdomyolysis include very high levels of potassium in the blood, which can lead to an irregular heartbeat or cardiac arrest and kidney damage (occurring in up to half of patients).

About one in four also develop problems with their liver. A condition called compartment syndrome can also occur after resuscitation with fluid. This serious compression of nerves, blood vessels and muscles can cause tissue damage and problems with blood flow.

Treatments

The early diagnosis and treatment of rhabdomyolysis and its causes are key to a successful outcome.

You can expect a full recovery with a quick treatment. Doctors can even reverse kidney damage. However, if compartment syndrome is not treated early enough, it can cause lasting damage.

If you have rhabdomyolysis, you will be admitted to the hospital to receive treatment for the cause. Treatment with intravenous (IV) fluids helps maintain urine output and prevent kidney failure.

Rarely, dialysis treatment may be necessary to help your kidneys filter waste products while they are recovering. The management of electrolyte abnormalities (potassium, calcium and phosphorus) helps protect your heart and other organs.

You may also need a surgical procedure (fasciotomy) to relieve tension or pressure and loss of circulation if the compartment syndrome threatens muscle death or nerve damage. In some cases, you may need to be in the intensive care unit (ICU) to allow close monitoring.

Most causes of rhabdomyolysis are reversible.

If rhabdomyolysis is related to a medical condition, such as diabetes or a thyroid disorder, appropriate treatment for the medical condition will be needed. And if rhabdomyolysis is related to a drug or drug, its use will have to be stopped or replaced with an alternative.

After the treatment, talk to your doctor about the necessary limitations in your diet or activity. And, of course, avoid the possible causes of rhabdomyolysis in the future.

Finally, any person who is suffering from similar conditions should try as far as possible to avoid self-medication, under the pretext of aggravating the symptoms causing them to derive from self-medication, other diseases perhaps more invasive and malignant to their health.

In this sense, it is advisable to always go to a specialist and follow the medical prescriptions to the letter to reduce the symptoms and development of the disease in a shorter period of time than expected, instead of extending it unnecessarily.

Keep in mind, as we have said above, that rhabdomyolysis is a reversible disease, as long as the treatment is carried out part by part.