How to Prevent Rhabdomyolysis

Rhabdomyolysis is a condition that occurs due to severe muscle damage and muscle breakdown. While it is relatively rare (about 26,000 cases are diagnosed in the United States each year), rhabdomyolysis is a life-threatening condition. Certain groups of people are at a higher risk of developing rhabdomyolysis. Please continue reading to learn more about the risk factors for rhabdomyolysis, its symptoms, and what you can do to prevent it.

What is rhabdomyolysis?

Rhabdomyolysis is a potentially dangerous condition in which there is severe skeletal muscle injury. The muscle damage leads to muscle breakdown and the death of muscle cells. Complications of this condition include acute kidney injury.

What triggers rhabdomyolysis?

The damaged skeletal muscle in rhabdomyolysis is a result of severe muscle injury. This condition was originally called crush syndrome when it was first identified in people with crushed limbs in the 1940s in London. The most common cause of injury to muscle cells is trauma, heat, and physical exertion. This is known as exertional rhabdomyolysis.

What is the most common cause of rhabdomyolysis?

Anything that can damage skeletal muscles can cause rhabdomyolysis. Some of the known causes are listed below.

Physical causes:

Heatstroke, severe dehydration, intense exercise, extreme exertion, car accidents, crush injuries, burns, and electrical shocks can cause damage to muscle fibers.

Infection and inflammation:

Bacterial and viral infections, snakebites, and inflammatory health conditions like dermatomyositis and polymyositis can trigger rhabdomyolysis.

Genetic and metabolic causes:

Rhabdomyolysis itself is not an inherited condition but certain genetic and metabolic disorders can increase the risk of developing it, for example, genetic disorders like muscular dystrophy.

Medications:

Rhabdomyolysis can be a rare side effect of cholesterol-lowering statin medications such as Lipitor, Crestor, and Pravachol. Other drugs like erythromycin, colchicine, and cyclosporine can also cause rhabdomyolysis. Rhabdomyolysis can occur in people who use illegal drugs like cocaine, LSD, Ecstasy, and amphetamines.

Why does muscle breakdown cause acute kidney injury?

One of the complications of rhabdomyolysis is acute renal failure (kidney failure). This occurs because the breakdown of muscles releases a protein called myoglobin into the blood. The kidneys remove myoglobin from the blood via urine. In severe cases of rhabdomyolysis, too much myoglobin is released into the blood and the kidneys cannot flush it out fast enough, leading to acute renal failure and potential death.

Who is at risk of muscle injury?

Anyone can get rhabdomyolysis, but certain groups of people are at higher risk, including:

Endurance athletes: Exertional rhabdomyolysis can occur in professional sportspersons, marathon runners, or anyone who does intense physical activity without adequate rest.
Military service members: Military boot camp and other types of intense training is associated with an increased risk of exertional rhabdomyolysis.
Firefighters: Physical exertion in hot temperatures is an occupational hazard for firefighters and a risk factor for rhabdomyolysis.
Older individuals: Older people who can’t get up after a fall and are not discovered for a long time can develop rhabdomyolysis due to inactivity.

What are the symptoms of rhabdomyolysis?

Rhabdomyolysis symptoms usually develop 1-3 days after the skeletal muscle damage. People with mild cases may only experience minor muscle soreness. More severe cases can have muscle pain, tenderness, swelling, and weakness. The breakdown of the muscle cells and the release of myoglobin can also lead to dark-colored urine (red, brown, or tea-colored urine). Dehydration can also occur with rhabdomyolysis and may cause symptoms such as decreased urination, nausea, and loss of consciousness.

Can rhabdomyolysis be treated at home?

If you suspect you have rhabdomyolysis, you should not try to treat the condition at home. Please see a doctor right away. Rhabdomyolysis is a potentially fatal condition. Early diagnostic evaluation and proper rhabdomyolysis treatment with medical expertise are essential for recovery.

How do doctors diagnose rhabdomyolysis?

Doctors diagnose rhabdomyolysis by asking about recent physical activity and obtaining a complete medical history; ordering a urine test to measure myoglobin levels; and ordering blood tests to measure creatine kinase levels (this is a protein found in skeletal muscles).

Once doctors have diagnosed rhabdomyolysis, they may order a muscle biopsy to identify the cause (this involves taking a small sample of skeletal muscle and sending it to the lab for testing).

What is the treatment for rhabdomyolysis?

Doctors treat rhabdomyolysis with IV fluids and electrolytes to help flush out toxins from the body. This may require a hospital stay for a few days. After the initial treatment and a period of rest, physical therapy is recommended to gradually strengthen the muscles.

In severe cases, rhabdomyolysis can cause kidney damage and kidney failure. Indeed, 50% of people with rhabdomyolysis experience acute kidney disease. Such patients may need dialysis for a short or extended time, depending on the extent of kidney damage.

It is possible to recover with proper and timely rhabdomyolysis treatment. However, many people have lingering muscle weakness and sore muscles for a few weeks after the muscle damage.

How can exercise-induced rhabdomyolysis be prevented?

You cannot prevent skeletal muscle damage that occurs in an accident. But it is possible to reduce your risk of developing exertional rhabdomyolysis. To lower your risk of getting exercise-induced rhabdomyolysis, you should:

Begin an exercise program slowly and get enough rest between workouts. Don’t push your physical limits beyond a point. Jumping into a high-intensity exercise program too quickly is a risk factor in developing rhabdo because the muscles don’t get time to heal.
Avoid overheating and severe dehydration. Heat causes faster muscle breakdown. The kidneys cannot flush out waste if you don’t drink enough fluids. If you are working out outdoors, take periodic breaks in the shade and stay hydrated.

Also, do not use illegal drugs or drink excessive alcohol. Certain medications can increase the risk of developing rhabdomyolysis. Talk to your doctor about this risk, especially if you have liver disease or diabetes.

When to see a doctor for muscle soreness or muscle pain?

If you have extremely sore muscles or weak muscles a few days after intense exercise, it could potentially be rhabdomyolysis. Watch out for muscle swelling and dark or brown urine. See a doctor right away if you have these symptoms. Rhabdomyolysis is a serious and life-threatening condition that requires immediate medical attention.

References: