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Rhabdomyolysis: Causes, Symptoms, Diagnosis, Treatment, and Prevention

A serious condition called rhabdomyolysis occurs when damaged muscle tissue breaks down and releases harmful substances into the bloodstream. As well as causing damage to the kidneys, these substances can also cause life-threatening complications. There are a variety of reasons for rhabdomyolysis, including physical trauma, extreme exercise, infections, medications, and genetic disorders. You should seek medical attention as soon as you recognize the signs and symptoms of rhabdomyolysis.

Causes of Rhabdomyolysis

Rhabdomyolysis can be triggered by anything that causes severe muscle damage or stress. Some of the common causes are:

• Crush injury: This can happen when a heavy object falls on or compresses a part of the body, such as in a car accident, a building collapse, or a natural disaster.

• Heat stroke: This can occur when the body overheats due to high temperatures, humidity, or lack of hydration. Heat stroke can cause muscle cells to rupture and leak their contents into the blood.

• Electrical shock injury: This can result from exposure to high-voltage electricity, such as from a lightning strike, a power line, or a defibrillator. Electrical currents can cause muscle contractions and damage.

• Extreme exercise: This can happen when a person engages in intense physical activity without proper preparation, rest, or hydration. This can include marathon running, weight lifting, military training, or sports. Excessive exercise can cause muscle inflammation and breakdown.

• Medications: Some drugs can have toxic effects on the muscles, especially when taken in high doses or in combination with other substances. These drugs include statins, antipsychotics, antidepressants, antivirals, and some antibiotics.

• Substance use disorder: Some illicit drugs and alcohol can interfere with the normal functioning of the muscles and the kidneys. These substances include heroin, cocaine, amphetamines, and ethanol.

• Infections: Some viral and bacterial infections can cause inflammation and damage to the muscles. These infections include influenza, HIV, herpes, sepsis, and tetanus.

• Genetic disorders: Some inherited conditions can affect the metabolism or structure of the muscles, making them more prone to breakdown. These conditions include McArdle’s disease, Duchenne’s muscular dystrophy, and carnitine deficiency.

Symptoms of Rhabdomyolysis

The symptoms of rhabdomyolysis can vary depending on the severity and the cause of the condition. Some of the common symptoms are:

• Muscle pain, weakness, or stiffness: This can affect the shoulders, thighs, lower back, or any other muscle group. The pain can be mild or severe, and may worsen with movement or pressure.

• Dark urine or decreased urination: This can indicate that the kidneys are not functioning properly and are unable to filter out the waste products from the blood. The urine may appear brown, red, or tea-colored, due to the presence of myoglobin, a protein that leaks from the damaged muscles.

• Nausea, vomiting, or loss of appetite: This can result from the accumulation of toxins in the blood, which can affect the digestive system and cause nausea, vomiting, or loss of appetite.

• Fever, confusion, or agitation: This can occur when the infection or inflammation spreads to the brain or other organs, causing fever, confusion, or agitation.

• Dehydration, electrolyte imbalance, or shock: This can happen when the fluid and electrolyte levels in the body are disrupted, leading to dehydration, electrolyte imbalance, or shock. This can cause symptoms such as thirst, dry mouth, dizziness, fainting, rapid heartbeat, low blood pressure, or seizures.

Diagnosis of Rhabdomyolysis

Rhabdomyolysis can be diagnosed by a physical examination and a series of tests. These tests include:

• The blood test can measure creatine kinase (CK), an enzyme produced when muscles are damaged. If the blood test shows a high level of creatine kinase (CK), rhabdomyolysis may be present. In addition to measuring myoglobin, lactate dehydrogenase (LDH), and troponin, the blood test can also assess the kidney function, electrolyte levels, and liver function.

• Urine test: This can detect the presence of myoglobin, blood, or protein in the urine, which can indicate muscle and kidney damage.

• Imaging test: This can include an X-ray, a CT scan, or an MRI, which can show the extent of the muscle injury, the presence of fractures, or the involvement of other organs.

Treatment of Rhabdomyolysis

The treatment of rhabdomyolysis depends on the cause and the severity of the condition. Its main objective is to prevent further muscle damage, restore fluid and electrolyte balance, and prevent complications in the kidneys and other organs. Treatment may include:

• Hydration, flushing out toxins from the blood, and prevention of kidney failure are all achieved through intravenous fluid therapy. The fluids may contain bicarbonate, which helps neutralize the acidity of the blood and prevent further muscle damage.

• The use of anti-inflammatory, painkiller, or antibiotic medication may reduce inflammation, pain, or infection. To reduce the risk of complications such as pulmonary embolism or stroke, it may be necessary to administer blood clot prevention drugs, such as heparin or warfarin.

• Dialysis: This is a procedure that uses a machine to filter the blood and remove the waste products, when the kidneys are unable to do so. Dialysis may be needed temporarily or permanently, depending on the extent of the kidney damage.

• An underlying cause of the muscle injury, such as a fracture, a burn, or compartment syndrome, may require surgery. The condition compartment syndrome is caused by swelling or bleeding in the muscle compartments, which can cause nerve and blood vessel damage. Surgery can relieve the pressure and restore blood flow to the affected area.

Prevention of Rhabdomyolysis

Rhabdomyolysis can be prevented by avoiding or minimizing the factors that can cause muscle damage or stress. Some of the preventive measures are:

• Drinking plenty of water and staying hydrated, especially during hot weather or intense exercise.

• Avoiding excessive alcohol consumption and illicit drug use, which can harm the muscles and the kidneys.

• Following the instructions and precautions when taking medications that can affect the muscles, such as statins, antipsychotics, or antivirals. Informing the doctor about any side effects or interactions with other drugs.

• Gradually increasing the intensity and duration of physical activity, and allowing adequate rest and recovery between workouts. Warming up before exercise and stretching after exercise can also help prevent muscle injury.

• Seeking medical attention promptly for any signs of infection, inflammation, or trauma, such as fever, pain, swelling, or bruising.

Outlook for Rhabdomyolysis

If rhabdomyolysis is diagnosed early, treated timely, and the cause is severe, the outlook is good. Most cases of rhabdomyolysis can be treated successfully and recover well. However, some cases can result in serious complications, including kidney failure, heart arrhythmia, and death. By early diagnosis and treatment, and by preventing further muscle damage, complications can be reduced.