RhabdomyolysisA breakdown of muscle fibers – called rhabdomyolysis – has various causes. Possible causes include muscle contusions. Taking medications. The decay can be mild, but can also lead to severe complications. Sometimes requires intensive treatment in the hospital.
At a glance
– The medical term rhabdomyolysis describes a breakdown of muscle fibers. – Triggers include muscle contusions and athletic overexertion, infections, the use of medications, and the use of alcohol and drugs. – The consequences of muscle breakdown range from mild muscle pain to acute kidney failure. – If there are signs of a severe course of the disease, rapid treatment in the hospital is necessary. There, complications can be avoided by intensive monitoring. Treatment usually well under control.
What is rhabdomyolysis?
Rhabdomyolysis is the term used to describe a breakdown of muscle fibers. Causes include muscle strains and extreme physical activity, taking certain medications or infections.
Muscle breakdown may be manifested by muscle pain or may go unnoticed. In some people, however, it leads to serious complications such as acute kidney failure. Must be treated quickly in the hospital – sometimes in the intensive care unit.
What are the symptoms of rhabdomyolysis??
Mild forms of rhabdomyolysis may go unnoticed. If not, the following symptoms are characteristic:
– Muscle pain – muscle weakness – reddish-brown urine
Typically, the pain is felt particularly in the muscle areas close to the torso, for example in the shoulders, thighs and low back. The muscles may also cramp.
Other signs – especially in severe courses – can be:
– general feeling of illness – fever – rapid pulse – abdominal pain – nausea and vomiting
Interesting to know: Urine may become discolored in rhabdomyolysis because a certain protein (myoglobin) from the decaying muscle fibers enters the bloodstream and is excreted by the kidneys. Myoglobin is responsible for oxygen transport in muscle cells and gives the muscle its red color.
What are the causes of rhabdomyolysis??
Rhabdomyolysis has a variety of causes. Common triggers include:
– muscle contusions as a result of an accident or impact – prolonged lying in the same position (immobility) – operations – extreme sports that overstrain the body – such as running a marathon without prior training – consumption of alcohol and drugs – taking medications, including cholesterol-lowering drugs: here especially the combination of fibrates and statins, especially in children – disturbed regulation of the salt balance (electrolyte disturbance) – overheating of the body (hyperthermia), for example due to heat stroke – side effect of treatment of mental illness with, for example, neuroleptics – side effect of treatment with anesthetics – a compartment syndrome: in this, fluid is deposited in the muscle tie as a result of an injury. This causes severe pain.
In rhabdomyolysis, several factors often come together.
How common is rhabdomyolysis??
Any person can develop rhabdomyolysis. However, it occurs more frequently in children under 10 years of age. People over the age of 60 on. People who are overweight as well as men are also more likely to develop rhabdomyolysis.
What are the complications of rhabdomyolysis??
Regardless of the specific trigger, in rhabdomyolysis cellular components are washed into the bloodstream. In the case of a very mild disintegration of the muscle fibers, there are practically no symptoms, but in severe forms, complications can arise that can be life-threatening.
A comparatively frequent complication is acute kidney failure: it is amed that the washed-in muscle protein myoglobin clogs the kidney tubules and damages the kidney cells. In addition, the blood supply to the kidneys is reduced. This reduces or even stops the production of urine.
A deficiency or excess of certain salts (electrolytes) in the blood are also among the typical consequences of rhabdomyolysis. For example, muscle cramps can occur when there is too little calcium in the blood (hypocalcemia). Conversely, the amount of potassium in the blood is often elevated (hyperkalemia), which increases the risk for cardiac arrhythmias.
Rarely happens that the washed-in substances activate blood clotting throughout the vascular system. In extreme cases, multiple organ failure occurs, affecting the lungs and liver.
In most people, the complications of rhabdomyolysis can be managed with intensive monitoring and treatment in the hospital. In this case, the causal muscle damage usually heals without consequences.
How rhabdomyolysis can be diagnosed?
A detailed patient interview serves to obtain the first important indications of a possible muscle breakdown. If rhabdomyolysis is suspected, it is confirmed with the help of laboratory tests.
Doctors usually ame a confirmed diagnosis when the amount of the protein creatine kinase in the blood is very elevated compared to the normal level. Creatine kinase enters the bloodstream from the decaying muscle cells. Is an indicator of the severity of the disease.
In addition, a urine test strip can quickly determine whether the muscle protein myoglobin is excreted in the urine and whether myoglobinuria is present.
An electrocardiogram (ECG) is also a standard diagnostic test for rhabdomyolysis, as the muscle breakdown often leads to cardiac arrhythmias.
How rhabdomyolysis is treated?
In principle, doctors first try to eliminate the cause of rhabdomyolysis. So are usually discontinued drugs that can trigger muscle breakdown. If the decay is due to athletic over-exertion, taking it easy physically for a few days and drinking plenty of fluids may be enough if the symptoms are very mild. However, this is for the physician to assess.
If there is a risk of complications, hospitalization is necessary. There, fluid is supplied through a d thin plastic tube in a larger vein ( venous catheter) to promote the excretion of harmful substances and prevent kidney failure.
A severe course may also require temporary renal replacement therapy (dialysis) and treatment in the intensive care unit – especially if potassium balance can no longer be regulated, which can result in life-threatening cardiac arrhythmias.
If a compartment syndrome is suspected to be the cause of muscle breakdown, surgeons are consulted for therapy.
Important to know: Despite the possible complications, treatment of rhabdomyolysis is successful in most people. About 80 percent of patients with marked muscle breakdown and renal failure recover.
References
– DynaMed [Internet], Ipswich (MA). Rhabdomyolysis. EBSCO Information Services. 2018 (1995). Record No. T114269. Retrieved 10.03.2021. – Gaik C, Wiesmann T. Rhabdomyolysis. An overview of pathophysiology, diagnosis, and therapy. Anesth Intensiv Med 2020;61:302-319. doi: 10.19224/ai2020.302. – UpToDate [Internet]. Causes of rhabdomyolysis. Wolters Kluwer 2021. Accessed on 10.03.2021. – Patel C, Kadiyala A. Rhabdomyolysis. BMJ Best Practice. Last updated: Nov 29, 2019. Retrieved 10.03.2021. – Scalco RS, Snoeck M, Quinlivan R et al. Exertional rhabdomyolysis: physiological response or manifestation of an underlying myopathy? BMJ Open Sport Exerc Med. 2016; 2(1): e000151. doi: 10.1136/bmjsem-2016-000151. – Stanley M, Adigun R. Rhabdomyolysis. [Updated July 10 2021]. In: StatPearls [Internet]. Treasure Island (FL). StatPearls Publishing; 2021 Jan-. Retrieved 08.02.2021.