Rhabdomyolysis is a serious condition that arises from muscle injury. When muscle fibers die because of direct or indirect injury, it releases toxic contents into the blood stream which can lead to pain, weakness, confusion and kidney failure. Causes of rhabdomyolysis include, but are not limited to the following:
- Motor vehicle crash
- Crush injury
- Excessive strenuous exercise
- Medication reaction
- Drug abuse
- Prolonged immobilization/pressure
Symptoms of rhabdomyolysis may sometimes be hard to pinpoint due to its variable course. The hallmark symptoms are weakness, muscle pain and “dark brown” urine. Many people who develop rhabdomyolysis may not have muscle related symptoms. Other symptoms include abdominal cramping, nausea/vomiting, increased heart rate, confusion and decreased urine output. Severe muscle pain associated with decreased urination with “dark brown” urine should prompt urgent medical care. Toxins released may lead to acute kidney failure if not treated aggressively. In rare severe cases, rhabdomyolysis in the extremities can cause severe swelling leading to a phenomenon called “compartment syndrome.” Compartment syndrome is due to excessive swelling that may cut off circulation to the extremity. Therefore, it is considered “limb-threatening” and require emergent surgical decompression.
Proper diagnosis begins with obtaining a good history and physical exam. Testing your blood for Creatine kinase (CK) is the most reliable test in diagnosing rhabdomyolysis. A urine test for myoglobin is also sometimes used in the work up for rhabdomyolysis, but considered less reliable. Other diagnostic tests may be ordered to check for complications of rhabdomyolysis or to rule out other problems.
Successful treatment for rhabdomyolysis is focused on early diagnosis. The main goal is to treat shock and preserve kidney function. Patients will often be admitted to the hospital for close monitoring and treatment. Aggressive hydration with oral and intravenous fluid should be initiated right away. Maintaining electrolyte balance helps protect other vital organs and in rare cases, dialysis may be used to help filter waste products due to kidney failure. Majority of rhabdomyolysis cases are treatable and reversible.
Early diagnosis and prevention is key in the treatment of rhabdomyolysis. For instance, exercise induced rhabdomyolysis can be prevented by doing the following:
- Exercise regularly with gradual increase in workout intensity
- Commit to dedicated training before strenuous competition or event (ie – marathon, iron man, triathlon, etc.)
- Hydrate aggressively before, during and after exercise