What is Rhabdomyolysis?
Rhabdomyolysis is a rare dangerous condition in which muscles that help the body to move (skeletal or striped muscles), breaks down rapidly and the breakdown products leaks into the blood stream.
Some of the products like the protein myoglobin gets filtered into the urine thereby paving the path to acute kidney failure. The term rhabdos comes from Greek word ‘rod’ + myo- + -lysis and literally means “dissolution of skeletal muscle.”
If the symptoms and signs of this condition are suspected, immediate medical attention is warranted. The early warning signs include:
- Severe muscular pain all over the body
- Muscle weakness
- Dark or cola-colored urine
The prognosis of the condition is bad if complication like acute kidney injury occur.
There is another condition called HyperCkemia, which is a less severe form of Rhabdomyolysis where the breakdown of the muscles in intermittent and this does not lead to kidney damage.
The causes of rhabdomyolysis include various factors, such as the following:
- Crush injury or any other trauma that damages skeletal muscle
- Drug addiction involving the use of drugs such as amphetamines, cocaine, heroin or phencyclidine (PCP). Alcohol intake is also associated with rhabdomyolysis
- Extreme body temperatures due to heat stroke or malignant hyperthermia. Malignant hyperthermia results in high body temperature on exposure to certain drugs used in general anesthesia. Neuroleptic malignant syndrome causes hyperthermia when the person is exposed to antipsychotic drugs
- Genetic muscle diseases like Duchene muscular dystrophy Becker’s dystrophy, metabolic enzymes deficiencies or mitochondrial function disorders
- Ischemia or reduced blood supply to muscles resulting in death to the muscle tissue
- Severe dehydration
- Seizures or muscle tremors
- Severe exertion, such as calisthenics or marathon running. Low blood potassium levels resulting from excessive sweating, exercise-induced asthma and sickle-cell trait can trigger rhabdomyolysis during exercise.
- Infections due to viruses like influenza type A and B virus, bacteria like leigionella, as well as fungal and parasitic infections
- Intake of medications like statins or a combination of statins with drugs like cyclosporine or gemfibrozil
- Electrolyte abnormalities like low or high sodium levels, low potassium levels and low phosphate levels. Low sodium levels may occur due to polydipsia (excessive intake of water), while low phosphate level may occur due to diabetic ketoacidosis. Endocrine disorders like hyperaldosteronism (excessive secretion of aldosterone), Addison’s disease hypothyroidism, hyperthyroidism and diabetic ketoacidosis
- Overweight with a (body mass index) BMI of >30% of ideal body mass
- Exposure to toxins from snake bites, spider venom and massive honey bee envomination
Any of the above factors causes breakdown on muscles, which causes the release of the muscle protein myoglobin as well as the contents of the muscle into the circulation. The excess myoglobin gets filtered by the kidneys, where they can cause kidney damage.
Statin and Risk of Rhabdomyolysis
Statins are cholesterol or lipid lowering medications. The overall risk of developing rhabdomyolysis from statin is extremely low at about 1.5 for each 100,000 people taking statins. If there is myalgia after taking statin, a blood test can give an early warning if there is muscle breakdown. Generally statins may cause mild forms of muscle inflammation and measurement of enzyme creatinine kinase in the blood can reassure the physicians and the patients of no untoward harm with the tablets.
Rhabdomyolysis risk is higher with higher the dose of statins and the risk increases if certain drugs like cyclosporine and gemfibrozil are taken in combination with statins.
Rhabdomyolysis is identified using a variety of symptoms and signs. The include:
- Generalised body or muscle aches with Muscle tenderness, muscle stiffness or aching known as myalgia
- Dark red or cola-colored urine
- Decreased urine output
- Weight gain
- Joint pain
There are a variety of complications that occur as a result of rhabdomyolysis. These include:
- Acute kidney failure
- Electrolytes abnormalities. The high potassium and low calcium levels lead to arrhythmias (irregular heartbeat). Volume depletion can result in hypovolemic shock
- Compartment syndrome caused by increased pressure within the muscle compartments. Compartment syndrome reduces oxygen supply to the muscle
- Lactic acidosis due to depletion of oxygen in affected tissues
- Disseminated intravascular coagulation, which results in widespread clotting and bleeding complications in the body. It is initiated by the released components of necrotic muscle tissue.
Diagnosis of rhabdomyolysis is based on the medical history obtained from the patient which may indicate an underlying precipitating factor, physical examination of the patient, and blood and urine tests. A high level of the enzyme creatine kinase in the blood (the CK-MM subtype) and myoglobin in the urine indicate the presence of rhabdomyolysis.
The main aim of the treatment of rhabdomyolysis is the prevention and treatment of any form of kidney damage. The underlying cause should also be treated.
- Because of low fluid volume in the body, fluid management is crucial along with maintaining an adequate urinary output goal. Fluids containing bicarbonates should be prescribed. Electrolyte abnormalities should be corrected. The urine output and other parameters should be monitored
- Dialysis is an option for the treatment of kidney failure
- Fasciotomy is required in compartment syndrome. Fasciotomy releases the tension within the muscle
- External cooling measures are used to treat hyperthermia and benzodiazepines are administered to control muscular hyperactivity. Further in malignant hyperthermia, anesthetics should be discontinued and dantrolene sodium should be used.
The prognosis or the outcome depends definitely on the amount of kidney damage. Acute renal failure in many people when treated will reduce the risk for permanent kidney damage. Patients with milder cases return to normalcy within a few weeks to a month. However, some patients still continue to have issues like fatigue and muscle pain.
Rhabdomyolysis causes kidney damage and hence the health tips focus mostly on protecting the kidneys. Following are a few lifestyle changes suggested for a person prone to rhabdomyolysis.
- Cut back on exercise: If rhabdomyolysis is caused by intense physical exertion for an athletic team or a marathon, then the intensity should be reduced.
- Eliminate drug abuse: The use of illegal drugs like cocaine should be eliminated.
- Improve circulation: Try to improve your circulation with intake of oranges, garlic, ginger, watermelon and dark chocolates.
- Improve kidney function: Foods that help in improving kidney health and its function include red peppers, garlic, cabbage, apples, raspberries, olive oil and egg whites.
- Intake of sufficient fluids: The best way to manage the condition is to take lots of fluids in the form of water or juices. This will increase urination and proper functioning of the kidneys. Thus, the toxic muscle components are cleared from the body quickly.
- Rhabdomyolysis - (https://medlineplus.gov/ency/article/000473.htm)
- Rhabdomyolysis from statins: What's the risk? - (http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/expert-answers/rhabdomyolysis/faq-20057817)
- Zeng X, Zhang L, Wu T, Fu P. Continuous renal replacement therapy (CRRT) for rhabdomyolysis. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD008566. DOI: 10.1002/14651858.CD008566.pub2
- Keltz E, Khan FY, Mann G. Rhabdomyolysis. The role of diagnostic and prognostic factors. Muscles Ligaments Tendons J. 2013 Oct-Dec; 3(4): 303–312
- Hohenegger M. Drug induced rhabdomyolysis. Curr Opin Pharmacol. 2012 Jun; 12(3): 335–339. doi: 10.1016/j.coph.2012.04.002
- Torres PA, Helmstetter JA, Kaye AM, Kaye AD. Rhabdomyolysis: Pathogenesis, Diagnosis, and Treatment. Ochsner J. 2015 Spring; 15(1): 58–69
- Staffa JA. Cerivastatin and Reports of Fatal Rhabdomyolysis. N Engl J Med 2002; 346:539-540February 14, 2002 DOI: 10.1056/NEJM200202143460721
Latest Publications and Research on Rhabdomyolysis
- Rhabdomyolysis - Exercise induced nightmare. - Published by PubMed
- Bromazepam intoxication in an infant: contribution of hair and nail analysis. - Published by PubMed
- Exercise-Induced Muscle Damage and Cardiac Stress During a Marathon Could be Associated with Dietary Intake During the Week Before the Race. - Published by PubMed
- Acute rhabdomyolysis following viral infection with coxsackie A4 in a 50-day-old infant with Fukuyama congenital muscular dystrophy. - Published by PubMed
- Cerivastatin for lowering lipids. - Published by PubMed