Rhabdomyolysis

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Rhabdomyolysis
Urine sample from a person with rhabdomyolysis
Synonyms
Pronounce
Specialty	Emergency medicine, Nephrology
Symptoms	Muscle pain, weakness, dark urine
Complications	Kidney failure, electrolyte imbalance, compartment syndrome
Onset
Duration
Types
Causes	Trauma, crush injury, prolonged immobilization, drug use, infection
Risks
Diagnosis	Blood test, urine test
Differential diagnosis
Prevention
Treatment	Intravenous fluids, dialysis
Medication
Prognosis
Frequency
Deaths

Rhabdomyolysis is a serious medical condition in which skeletal muscle tissue breaks down rapidly, releasing a protein called myoglobin into the bloodstream. Myoglobin can cause kidney damage, as it can be toxic to the renal tubules and ultimately lead to acute kidney injury or even kidney failure. Rhabdomyolysis can be caused by various factors, including muscle injury, extreme physical exertion, certain medications, drug abuse, infections, and genetic disorders.

Rhabdomyolysis

Causes

Some common causes of rhabdomyolysis include:

• Trauma or muscle injury: accidents, crush injuries, or burns can result in muscle damage and rhabdomyolysis.
• Extreme physical exertion: intense exercise, particularly in hot and humid conditions, can lead to muscle breakdown and rhabdomyolysis.
• Medications: statins (used to lower cholesterol), antipsychotics, and certain diuretics can contribute to rhabdomyolysis.
• Drug abuse: the use of illegal drugs, such as cocaine or amphetamines, can increase the risk of rhabdomyolysis.
• Infections: bacterial or viral infections, such as the flu or sepsis, can cause muscle damage and rhabdomyolysis.
• Genetic disorders: some inherited conditions, such as McArdle's disease or Duchenne muscular dystrophy, can make individuals more susceptible to rhabdomyolysis.
• Electrolyte imbalances: abnormal levels of electrolytes, such as potassium, calcium, or sodium, can lead to rhabdomyolysis.
• Prolonged immobilization: lying down for an extended period, particularly after a fall or injury, can cause muscle compression and rhabdomyolysis.

Symptoms

Symptoms of rhabdomyolysis can vary and may include:

• Muscle pain, weakness, or stiffness
• Dark red or brown urine
• Decreased urine output
• Fatigue
• Swelling or tenderness in the affected muscles
• Nausea and vomiting

In severe cases, rhabdomyolysis can cause additional complications such as:

• Acute kidney injury or kidney failure
• Irregular heartbeat (arrhythmia)
• Electrolyte imbalances, which can lead to seizures or other complications
• Disseminated intravascular coagulation (DIC), a blood clotting disorder

Renal Tubules of Exertional Rhabdomyolysis

Diagnosis

Rhabdomyolysis is typically diagnosed based on clinical symptoms, medical history, and laboratory tests. Blood tests may reveal elevated levels of creatine kinase (CK) – an enzyme released when muscles are damaged – and myoglobin. A urine test may also be conducted to detect the presence of myoglobin in the urine.

Treatment

Treatment for rhabdomyolysis focuses on addressing the underlying cause and preventing complications, particularly kidney damage. Common treatment approaches include:

• Intravenous (IV) fluids: providing fluids helps to maintain urine production and flush out myoglobin from the kidneys.
• Electrolyte monitoring and management: monitoring and correcting electrolyte imbalances, such as potassium and calcium, can help prevent complications.
• Dialysis: in cases of severe kidney damage or kidney failure, dialysis may be necessary to filter waste products and excess fluid from the blood.
• Medication adjustments: if rhabdomyolysis is caused by a specific medication, the healthcare provider may discontinue or adjust the dosage of that drug.
• Rest and pain management: allowing affected muscles to rest and recover, along with appropriate pain management, can help alleviate symptoms.

Prevention

• Preventing rhabdomyolysis involves reducing risk factors and being aware of potential triggers, such as:
• Gradually increasing the intensity of exercise and avoiding excessive physical exertion, particularly in extreme weather conditions.
• Staying well-hydrated, especially during physical activity.
• Informing healthcare providers about all medications being taken, to help them identify any potential interactions or risks.
• Avoiding the use of illicit drugs or substances that may contribute to muscle injury.
• Seeking prompt medical attention for any symptoms suggestive of rhabdomyolysis, such as muscle pain, weakness, or dark urine.

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