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- 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
- Cocaine (most common recreational drug), methamphetamine, phencyclidine, heroin, bath salts (1)[B], synthetic marijuana has been associated with severe rhabdomyolysis (2)[A].
- 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 (2)[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.