Rhabdomyolysis

Overview

What is rhabdomyolysis?

Rhabdomyolysis can be a life-threatening condition caused by muscle breakdown and muscle death. This dangerous muscle damage can result from overexertion, trauma, toxic substances or disease.

As muscle cells disintegrate, they release a protein called myoglobin into the blood. The kidneys are responsible for removing this myoglobin from the blood so urine can flush it out of the body.

In large quantities, myoglobin can damage the kidneys. If the kidneys cannot get rid of the waste fast enough, kidney failure and death can occur.

How common is rhabdomyolysis?

Rhabdomyolysis (also called rhabdo) is relatively rare. Every year, about 26,000 people develop this condition.

Who is affected by rhabdomyolysis?

Although rhabdomyolysis can happen to anyone, certain groups have a higher risk than others of developing the condition. People with an increased chance of getting rhabdomyolysis include:

  • Endurance athletes: Marathon runners, people who take spin classes, and others who do high-intensity interval exercises have a higher risk of getting rhabdomyolysis. These groups may push themselves too hard without resting.
  • Firefighters: Firefighters can develop the condition after physical exertion in hot temperatures. Overheating can cause rhabdomyolysis.
  • Service members: People in the military, especially those who are in boot camp or are undergoing intense training, have an increased risk of developing rhabdomyolysis.
  • Older people: People who fall, can’t get up, and aren’t discovered for an extended time can get rhabdomyolysis.

Symptoms and Causes

How do people get rhabdomyolysis?

Several factors can lead to rhabdomyolysis. Causes of rhabdomyolysis include:

  • High-intensity exercise: Jumping into an exercise program too fast can lead to rhabdomyolysis when muscles don’t have time to heal after an intense workout.
  • Severe dehydration and overheating: Heat causes faster muscle breakdown. Your kidneys can’t dispose of all the waste without plenty of fluids.
  • Trauma: A severe burn, lightning strike, or crushing injury can cause muscle fibers to disintegrate rapidly.
  • Medications: Some medications can cause muscle breakdown, including antipsychotic, antidepressant, and antiviral drugs. Statin medications can also lead to rhabdomyolysis, especially in people who have diabetes or liver disease.
  • Illegal drugs and alcohol: Heroin, LSD, cocaine, and excessive alcohol are toxic to the body and can cause muscles to deteriorate.
  • Long periods of inactivity: People who fall, lose consciousness, and can’t get up for an extended time can develop rhabdo.

Can rhabdomyolysis be inherited?

Rhabdomyolysis itself cannot be inherited (passed down in families). But certain genetic disorders can increase your risk of developing the condition. People can get rhabdomyolysis as a result of an inherited muscle disease (such as muscular dystrophy).

People who have certain metabolic or mitochondrial disorders also have a higher risk of rhabdomyolysis. A metabolic disorder affects the way energy moves into the cells. Mitochondrial disorders occur when your body doesn’t correctly produce energy for your cells.

What are the symptoms of rhabdomyolysis?

Rhabdomyolysis symptoms can range from mild to severe. Symptoms usually develop one to three days after the muscle injury, though some people may not even notice muscle soreness. The main signs of rhabdomyolysis include:

  • Muscle swelling.
  • Weak, tender and sore muscles.
  • Dark urine that is brown, red or tea-colored.

Some people also experience dehydration or decreased urination, nausea, or loss of consciousness.

Diagnosis and Tests

How is rhabdomyolysis diagnosed?

To diagnose rhabdomyolysis, your doctor will:

  • Examine you and ask about recent physical activity, prescription medications, and alcohol or drug use.
  • Order a urine test to check the levels of myoglobin in your urine.
  • Take a sample of your blood to measure levels of creatnine kinase, a protein that muscles release when they disintegrate.

After a diagnosis of rhabdomyolysis, doctors may order a muscle biopsy to find the cause. For a muscle biopsy, your doctor will:

  • Numb the area.
  • Take a small sample of your muscle.
  • Send the sample to a lab for testing.

Your doctor may also recommend a blood test to see if you have a genetic condition that increases your risk of developing rhabdomyolysis.

How do I know if I have rhabdomyolysis?

If you have extremely sore or weak muscles a few days after exercising, you may have rhabdomyolysis. You should also look out for muscle swelling and dark urine. If you have these symptoms, see your doctor right away to get tested and treated for rhabdomyolysis.

Management and Treatment

What are the treatments for rhabdomyolysis?

To treat rhabdomyolysis, your doctor will first give you fluids and electrolytes intravenously (through a vein). These IV fluids flush the toxins from your system. You may need to stay in the hospital for a few days. After treatment, physical therapy can help you strengthen your muscles after an initial period of rest.

If the rhabdomyolysis is severe enough to cause kidney damage, you may need dialysis. Dialysis extracts (removes) some of your blood, takes out toxins, and returns the filtered blood.

What are the side effects of the treatment for rhabdomyolysis?

During dialysis, some people experience a drop in blood pressure, which can cause nausea, vomiting, and headaches. These side effects usually go away with repeated dialysis treatments. You may feel tired or weak for a few hours after a dialysis treatment.

What are the complications associated with rhabdomyolysis?

If rhabdomyolysis is severe, it can damage the kidneys and lead to kidney failure. Rhabdomyolysis can be deadly if it isn’t treated.

What can I do to help relieve symptoms of rhabdomyolysis?

If you have symptoms of rhabdomyolysis, you should not try to relieve them. You should see your doctor right away.

Rhabdomyolysis can be life-threatening. Early diagnosis and treatment are essential to recovery.

Prevention

How can you prevent rhabdomyolysis?

You may not be able to prevent rhabdomyolysis that occurs as a result of an accident. But you can reduce your risk of developing exercise-induced rhabdomyolysis. To lower your risk of getting rhabdomyolysis, you should:

  • Start an exercise program slowly, and listen to your body. If you feel especially sore or tired during a workout, stop and rest. Don’t push yourself beyond safe limits.
  • Stay hydrated and avoid getting overheated. Take breaks in the shade if you’re doing physical activity in the heat.
  • Don’t abuse alcohol or take illegal drugs.
  • Talk to your doctor about any medications you’re taking that may increase your risk of developing rhabdomyolysis. Be especially careful if you have diabetes or liver disease.

Outlook / Prognosis

What is the outlook for patients who have rhabdomyolysis?

Many people recover after rhabdomyolysis treatment. But most people have lingering muscle weakness for a few weeks after the injury. In up to 50% of rhabdomyolysis cases, people experience acute kidney injury. Some people need dialysis for an extended time if their kidneys cannot function.

Living With

When should I call my doctor about rhabdomyolysis?

If you continue to have muscle pain, weakness, or swelling a few days after exercise, you should call your doctor right away. Rhabdomyolysis is a serious condition that requires immediate medical attention.

Last reviewed by a Cleveland Clinic medical professional on 12/04/2019.

References

  • Nance JR, Mammen AL. Diagnostic evaluation of rhabdomyolysis. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4437836/) Muscle Nerve. 2015 Jun;51(6):793-810. Accessed 12/5/2019.
  • The Myositis Association. Rhabdomyolysis. (https://www.myositis.org/about-myositis/complications/rhabdomyolysis/) Accessed 12/5/2019.
  • Vanholder R, Sever MS, Erek E, Lameire N. Rhabdomyolysis. (https://jasn.asnjournals.org/content/11/8/1553) JASN Aug 2000, 11 (8) 1553-1561. American Society of Nephrology. Accessed 12/5/2019.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy