If you are pushing your limits in the gym or on the field, rhabdomyolysis can be an unseen danger, often lurking unnoticed until it leads to severe health issues. This condition involves muscle breakdown that can result in kidney damage, electrolyte imbalances, and potentially life-threatening conditions. It is often triggered by factors like trauma, extreme physical exertion, infections, or medications.
This guide offers a clear overview of its causes, symptoms, prevention, and treatment of rhabdomyolysis. Knowing when to seek medical help and recognising the warning signs is crucial to managing and preventing this condition.
What is rhabdomyolysis?
Rhabdomyolysis, or rhabdo, is a serious medical condition characterised by the dissolution of the injured skeletal muscle tissue. The rapid breakdown of injured muscle tissues releases cell contents, myoglobin, electrolytes, and sarcoplasmic proteins such as creatinine kinase into the extracellular fluid and the bloodstream. The severity can range from mild elevation in creatinine phosphokinase to medical emergencies such as compartment syndrome, fluid depletion, acute kidney injury (AKI), and cardiac arrhythmias.
What is the main cause of rhabdomyolysis?
The rhabdomyolysis causes can be broadly categorised into traumatic and nontraumatic. Key factors contributing to traumatic rhabdomyolysis include trauma and compression, crush and electrical injuries, exertion, muscle hypoxia, and alteration in the body temperature.
Nontraumatic rhabdomyolysis is commonly associated with drugs and toxins, electrolyte imbalances, endocrine disorders, infections, autoimmune disorders, genetic defects, myopathies, and alcohol consumption.
What are the warning signs of rhabdomyolysis?
Some individuals may not exhibit any rhabdomyolysis symptoms, and the condition is often diagnosed incidentally during the blood tests performed for other medical issues.
The primary warning signs of rhabdomyolysis to look out for include:
- Muscle cramps, aches and pain
- Dark-colored urine
- Fatigue
- Muscle weakness
Additionally, systemic symptoms like fever, malaise, abdominal pain, nausea, and vomiting are also commonly seen.
How is rhabdomyolysis diagnosed?
To diagnose rhabdomyolysis, your doctor will examine and palpate larger skeletal muscles, particularly those that are painful, to assess for tenderness. They may also conduct urine and blood tests to confirm a rhabdomyolysis diagnosis.
Key tests to evaluate muscle and kidney health may include:
- Creatine kinase (CK): Elevated levels of this enzyme, which is found in the skeletal muscles, brain, and heart, indicate muscle damage.
- Myoglobin in blood and urine: It is a protein released during muscle breakdown. The high levels can signal muscle injury.
- Potassium levels: This vital mineral can leak from damaged muscles and bones.
- Creatinine in blood and urine: A waste product generated by injured muscles that is typically cleared by the kidney. The elevated levels of this substance in the blood are a strong indicator of muscle damage.
How is rhabdomyolysis treated?
Rhabdomyolysis treatment depends on its cause and severity, with most patients requiring hospitalisation. Your doctor will address the underlying cause and manage complications resulting from muscle breakdown. The common treatment usually includes:
- IV fluids: Fluids administered through a thin tube into a vein help flush out harmful substances released by damaged muscle cells.
- Medications: Drugs such as bicarbonate and diuretics can be used to correct your electrolyte imbalances.
- Kidney damage management: If kidney function is affected, treatment may involve reducing or stopping medicines that could worsen kidney problems, dietary adjustments, or dialysis. Dialysis, also called kidney replacement therapy, temporarily performs the kidneys’ functions.
- Treat compartment syndrome: In rare cases, patients with rhabdomyolysis experience compartment syndrome, an emergency condition involving an abnormal buildup of pressure in a muscle group. Treatment of this condition typically requires surgery to cut the surrounding tissue and relieve pressure.
How can I manage rhabdomyolysis?
In cases of mild rhabdomyolysis, home remedies can aid the recovery process. The main focus is to allow the muscles to heal and stay hydrated to reduce rhabdomyolysis and prevent further kidney damage.
- Rest: Give your body time to recover by avoiding strenuous activities, and if you feel fatigued, recline in a comfortable position and focus on relaxation.
- Hydration: Drink plenty of water and clear fluids, such as light broths or sports drinks, to help flush out harmful substances and maintain electrolyte balance.
How can I prevent rhabdomyolysis?
To reduce the risk of rhabdomyolysis, prioritise hydration and proactive health care:
- Take fluids before and after exercise: Drinking plenty of fluids can help dilute your urine and support your kidneys in clearing myoglobin released during strenuous activity.
- Maintain hydration during muscle stress: Proper hydration should be maintained if you have a degenerative muscle condition or have recently experienced muscle trauma or stress, to help prevent rhabdomyolysis.
- Carry a refillable water bottle: Keep water accessible throughout the day and drink whenever you feel thirsty and do not wait for your thirst to intensify.
- Seek medical care promptly: If you suspect you are sick or have an infection, visit your doctor at the earliest. Addressing health issues promptly can help prevent muscle damage that could lead to rhabdomyolysis.
Can I fully recover from rhabdomyolysis?
The prognosis for rhabdomyolysis depends on its cause, but most of the patients with acute kidney injury, experience favourable outcomes with full recovery of kidney function. However, some individuals are more likely to experience a recurrence. Factors that increase the recurrence rate include:
- Genetic disorders like muscular dystrophy or metabolic myopathy can predispose individuals to repeated episodes.
- The misuse of recreational drugs or alcohol significantly increases the likelihood of recurrence.
What are the complications of rhabdomyolysis?
Rhabdomyolysis can lead to several serious complications, including:
- Acute kidney injury
- Electrolyte abnormalities
- Arrhythmias
- Compartment syndrome
- Disseminated intravascular coagulation
- End-stage renal disease
- Infections from a prolonged hospitalisation
What are the myths and misconceptions regarding rhabdomyolysis?
There is a common misconception that rhabdomyolysis affects only unfit or out-of-shape people. This is not true. People with excellent physical condition, such as marathon runners, firefighters, and professional athletes, are also at risk of rhabdomyolysis. It can occur in anyone, even after activities that have previously been done without issue.
Additionally, people have the false belief that dehydration causes rhabdomyolysis. While dehydration doesn’t directly cause rhabdo, it can exacerbate the condition. Dehydration hinders the body’s ability to eliminate the proteins and electrolytes released from damaged muscles, which can lead to further organ damage, particularly in the kidneys.
References
- Stanley, M., Chippa, V., Aeddula, N. R., Quintanilla Rodriguez, B. S., & Adigun, R. (2023). Rhabdomyolysis. In StatPearls. StatPearls Publishing. Rhabdomyolysis – StatPearls – NCBI Bookshelf (nih.gov)
- Torres, P. A., Helmstetter, J. A., Kaye, A. M., & Kaye, A. D. (2015). Rhabdomyolysis: pathogenesis, diagnosis, and treatment. Ochsner journal, 15(1), 58–69. Rhabdomyolysis: Pathogenesis, Diagnosis, and Treatment – PMC (nih.gov)
- Rhabdomyolysis – ScienceDirect
- Patient education: Rhabdomyolysis (The Basics) – UpToDate
- Rhabdomyolysis and Work | Rhabdomyolysis | CDC
- Rhabdomyolysis: Symptoms, Causes, Treatment, and More (healthline.com)
- Rhabdomyolysis: Symptoms, Causes & Treatments (clevelandclinic.org)
