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Rhabdomyolysis

Rhabdomyolysis is a topic covered in the 5-Minute Clinical Consult.

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5-Minute Clinical Consult

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Basics

Description

  • 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.

Epidemiology

Incidence
26,000 hospitalizations annually in United States

Etiology and Pathophysiology

Risk factors

  • 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)
    • Seizures
    • Delirium tremens
  • Drugs and toxins
    • Alcohol
    • 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)
    • Zidovudine
    • Antimalarials
    • HMG-CoA reductase inhibitors (statins) (risk <0.01%—elevated with higher doses and in combination with fibrates)
    • Colchicine
    • Corticosteroids
    • Carbon monoxide
    • Snake envenomation
  • Muscle ischemia
    • Thrombosis, embolism, sickle cell disease
    • Compartment syndrome
    • Tourniquets
  • Infections
    • Viral: influenza A and B, coxsackievirus, HIV, varicella
    • Bacterial: Streptococcus or Staphylococcus sepsis, gas gangrene, necrotizing fasciitis, Salmonella, Legionella
    • Malaria
  • Hypothermia
  • Hyperthermia
  • Autoimmune disorders
    • Polymyositis, dermatomyositis
  • Metabolic and endocrinologic:
    • Hypothyroidism or thyrotoxicosis
    • Electrolyte imbalances (e.g., hyponatremia, hypernatremia, hypokalemia, hypocalcemia, hypophosphatemia)
    • Diabetic ketoacidosis
    • Hyperosmolar state
Genetics

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

General Prevention

  • Avoid excessive exertion; ensure adequate hydration.
  • Avoid precipitating drugs, metabolic and electrolyte abnormalities.

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Citation

Stephens, Mark B., et al., editors. "Rhabdomyolysis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. 5minute, www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816583/all/Rhabdomyolysis.
Rhabdomyolysis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816583/all/Rhabdomyolysis. Accessed July 23, 2019.
Rhabdomyolysis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816583/all/Rhabdomyolysis
Rhabdomyolysis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 July 23]. Available from: https://www.unboundmedicine.com/5minute/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 - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816583/all/Rhabdomyolysis PB - Wolters Kluwer ET - 27 DB - 5minute DP - Unbound Medicine ER -