Rhabdomyolysis

What is it?

• A breakdown of muscle fibers caused by extreme overload to the muscles.
• Damage to muscle causes the release of muscle fiber (myoglobin – protein pigment) into the bloodstream.
• Myoglobin breakdown may cause severe kidney blockage and damage.

Causes
Skeletal muscle damage due to:

• Trauma: auto accident, fall, blast, crush
• Extreme physical exercise – abrupt increase
• Poor hydration
• Hypothermia, drowning
• Drug (cocaine)/alcohol + hyperthermia
• Medications: Statins (Zocor, Lipitor, Pravachol, Mevacor)
• Low electrolytes: potassium, phosphate, magnesium

Symptoms

• Muscle soreness, pain, tenderness, weakness
• Swelling
• Dark, cola or red colored urine
• Joint pain
• Fatigue, dizziness, nausea, vomiting
• Seizures

Complications

• Acute kidney failure
• Compartment syndrome
• Hyperkalemia
• Hyperphosphatemia

Risk Factors

• Genetics
• Abrupt increase in exercise, especially eccentric muscle contraction
• Being out-of-shape and beginning a hard exercise program
• Hot weather/heat stroke – heat intolerance
• NSAID use
• Diabetes
• Sickle Cell Disease
• Alcoholism
• Drug use – cocaine, steroids

Diagnosis

• Physical examination of muscles: tenderness, compartment syndrome
• Urinalysis – blood
• Blood work
  • Creatine phosphokinase
  • Electrolytes
  • Liver enzymes
  • Serum myoglobin

Treatment
Goal - Preserve kidney function and treat shock

• Fluids – oral rehydration, IV fluid
• Electrolyte replacement
• Discontinue toxic medication

Prognosis

• Favorable and reversible if treated promptly
• In severe compartment syndrome multiple surgeries may be necessary causing permanent damage to the muscle(s)

Prevention

• Avoid extreme exertion in the heat
• Gradual ramping up of fitness level: aerobic exercise and weight training
• Recovery nutrition: protein and hydration
• Pay attention to symptoms – get examined and treated!
• Buddy system between athletes when training/game
• Good communication between all parties: athletes, coaches and parents

See:
Rhabdomyolysis in High School athlete

Rhabdomyolysis in Collegiate Athletes - Iowa

Exertional Heat Illness, Exertional Rhabdomyolysis, and Malignant Hyperthermia: Is There a Link?

Rhabdomyolysis in 119 students after repetitive exercise

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