- Breakdown of skeletal muscle with systemic release of intracellular contents
- Rhabdomyolysis typically presents with muscle pain, weakness, and reddish brown (tea-colored) urine. Up to 50% of patients are asymptomatic.
26,000 hospitalizations annually in United States
Etiology and Pathophysiology
- Direct muscle trauma (most common cause)
- Crush injuries
- Extended periods of muscle pressure (during surgery, unconscious from alcohol ingestion)
- Burns, electrocution, lightning strike
- Muscle exertion
- Intense and/or prolonged physical exercise (marathon runners, athletes, contact sports)
- Delirium tremens
- Drugs and toxins
- Antipsychotics (due to neuroleptic malignant syndrome, malignant hyperthermia, and dystonia)
- HMG-CoA reductase inhibitors (statins) (risk <0.01%—elevated with higher doses and in combination with fibrates)
- Carbon monoxide
- Snake envenomation
- Muscle ischemia
- Thrombosis, embolism, sickle cell disease
- Compartment syndrome
- Viral: influenza A and B, coxsackievirus, HIV, varicella
- Bacterial: Streptococcus or Staphylococcus sepsis, gas gangrene, necrotizing fasciitis, Salmonella, Legionella
- Autoimmune disorders
- Polymyositis, dermatomyositis
- Metabolic and endocrinologic:
- Hypothyroidism or thyrotoxicosis
- Electrolyte imbalances (e.g., hyponatremia, hypernatremia, hypokalemia, hypocalcemia, hypophosphatemia)
- Diabetic ketoacidosis
- Hyperosmolar state
Hereditary causes of rhabdomyolysis are rare but should be suspected in children; patients with recurrent attacks; or patients who have attacks after minimal exertion, mild illness, or starvation.
- Genetic disorders (1)[C]
- Muscular dystrophies
- Disorders of lipid metabolism (e.g., carnitine palmitoyltransferase deficiency)
- Disorders of carbohydrate metabolism (i.e., phosphofructokinase deficiency, phosphoglycerate mutase, myophosphorylase deficiency, a.k.a. McArdle disease/deficiency)
- Glycogen storage diseases (e.g., phosphorylase B kinase deficiency) and others (e.g., lactate dehydrogenase A deficiency)
- Mitochondrial disorders
- Avoid excessive exertion; ensure adequate hydration.
- Avoid precipitating drugs, metabolic and electrolyte abnormalities.
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Domino, Frank J., et al., editors. "Rhabdomyolysis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816583/all/Rhabdomyolysis.
Rhabdomyolysis. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816583/all/Rhabdomyolysis. Accessed May 30, 2023.
Rhabdomyolysis. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816583/all/Rhabdomyolysis
Rhabdomyolysis [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 May 30]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816583/all/Rhabdomyolysis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Rhabdomyolysis ID - 816583 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816583/all/Rhabdomyolysis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -