Rhabdomyolysis

What is rhabdomyolysis?

Rhabdomyolysis (pronounced “rab-doe-my-ah-luh-suhs”) is a condition that causes your muscles to break down (disintegrate), which leads to muscle death. When this happens, toxic components of your muscle fibers enter your circulation system and kidneys. This can cause kidney damage.

This dangerous muscle condition can result from overexertion, trauma, medications or an underlying health condition. Common signs and symptoms of rhabdomyolysis are weak muscles, muscle stiffness, muscle pain and a change in your pee color.

You may hear rhabdomyolysis referred to as “rhabdo.”

Rhabdomyolysis can be life-threatening, so if you notice any of these signs or symptoms, visit a healthcare provider immediately.

How common is rhabdomyolysis?

Rhabdomyolysis is relatively uncommon. Every year, about 26,000 people in the United States develop this condition.

What are the signs and symptoms of rhabdomyolysis?

Signs and symptoms of rhabdomyolysis include:

• Muscle swelling.
• Weak muscles.
• Tender and sore muscles.
• Dark pee that’s brown, red or tea-colored.

Rhabdomyolysis symptoms can range from mild to severe. Symptoms usually develop one to three days after a muscle injury, though some people may not even notice muscle soreness.

Some people also experience:

• Dehydration.
• Decreased urination.
• Nausea.
• Loss of consciousness.

What causes rhabdomyolysis?

Causes of rhabdomyolysis include:

• Injury or trauma: A severe burn (especially ones that cover a large surface area), electrocution or crushing injury can cause muscle fibers to break down rapidly. A crushing injury is one of the most common causes of rhabdomyolysis.
• High-intensity exercise: Jumping into an exercise program too fast can lead to rhabdomyolysis when your 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 your body’s waste without plenty of fluids.
• Medications: Some medications can cause muscle breakdown, including antipsychotic, antidepressant and antiviral medications. Statin medications can also lead to rhabdomyolysis, especially when they treat diabetes or liver disease.
• Substance use disorder: Heroin, LSD, cocaine and alcohol are toxic to your body and can cause your muscles to deteriorate.
• Long periods of inactivity: People who fall, lose consciousness and can’t get up for an extended period can develop rhabdomyolysis.
• Certain medical conditions: Genetic conditions like McArdle disease and Duchenne muscular dystrophy can lead to rhabdomyolysis. Also, certain metabolic or mitochondrial conditions have a higher risk of rhabdomyolysis.

What happens to muscles during rhabdomyolysis?

Rhabdomyolysis causes your muscles to break down and deteriorate. This makes components of your muscles leak into your circulation system (blood), including large amounts of:

• Potassium.
• Phosphate.
• Myoglobin.
• Creatine kinase (CK).
• Urate.

Your kidneys are responsible for removing these components from your blood so you can get rid of them in your pee. In large quantities, these muscle components damage your kidneys. If your kidneys can’t get rid of your body’s waste fast enough, kidney failure can occur. This can be life-threatening.

Can you inherit rhabdomyolysis?

You can’t inherit rhabdomyolysis. Certain genetic conditions can increase your risk of developing the condition. You can develop rhabdomyolysis if you have an inherited muscle disease like muscular dystrophy.

What are the risk factors for rhabdomyolysis?

Rhabdomyolysis can happen to anyone. However, you may be more at risk of developing rhabdomyolysis if you’re:

• An endurance athlete: Marathon runners, people who take spin classes and others who do high-intensity interval exercises have a higher risk of getting rhabdomyolysis. Occasional endurance activities don’t cause this condition. Your risk increases if you push yourself too hard without resting.
• Working in hot environments: Firefighters, foundry workers and other people who work in hot environments that involve heavy physical exertion can develop this condition. Overheating can cause rhabdomyolysis or make it easier for it to happen.
• In the military: People in the military, especially those who are in boot camp or are undergoing intense training, have an increased risk of developing rhabdomyolysis.
• Above 65 years of age: If you’re above age 65, you may be more at risk of falling without being able to get up. Extended periods of inactivity can lead to rhabdomyolysis.

What are the complications of rhabdomyolysis?

Complications of rhabdomyolysis include:

• Kidney damage or kidney failure.
• Electrolyte level abnormalities.
• Metabolic acidosis.
• Compartment syndrome.
• Disseminated intravascular coagulation.

Rhabdomyolysis can be life-threatening if it isn’t treated quickly.

How is rhabdomyolysis diagnosed?

Your healthcare provider will diagnose rhabdomyolysis by:

• Examining you and asking about your recent physical activity, prescription medications and substance use.
• Ordering a urine test to check the levels of myoglobin (a component of broken-down muscle) in your pee.
• Taking a sample of your blood to measure creatine kinase (CK) levels, a protein that muscles release when they break down.

After a diagnosis of rhabdomyolysis, your healthcare provider may order a muscle biopsy test. 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 provider 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 healthcare provider right away to get tested and treated for rhabdomyolysis.

How is rhabdomyolysis treated?

Treatment for rhabdomyolysis includes supportive therapy, like:

• Receiving 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 to receive these fluids.
• Participating in physical therapy can help you strengthen your muscles after an initial period of rest.
• Undergoing dialysis if you have severe kidney damage. Dialysis extracts (removes) some of your blood, takes out toxins and returns the filtered blood.

Are there side effects of the treatment?

Side effects of treatment could include:

• Discomfort from an IV in your vein.
• Sore or weak muscles.
• Nausea, vomiting or headaches caused by a drop in your blood pressure during dialysis.
• Fatigue.
• Infections around IV needle insertion points.

The side effects of dialysis usually go away with repeated dialysis treatments.

How soon after treatment will I feel better?

If you don’t have any complications caused by rhabdomyolysis, you may feel better within a few weeks. Resting helps you feel better during treatment. Your healthcare provider may recommend you wait several weeks to months before resuming exercise activities again. Don’t exercise until your healthcare provider tells you it’s safe.

Can rhabdomyolysis be prevented?

You can’t prevent all causes of rhabdomyolysis, especially if an underlying condition or an accident caused it.

You can reduce your risk of developing exercise-induced rhabdomyolysis by:

• Starting an exercise program slowly, and listening to your body. If you feel especially sore or tired during a workout, stop and rest. Don’t push yourself beyond safe limits.
• Staying hydrated and avoid getting overheated. Take breaks in the shade if you’re doing physical activity in the heat.
• Avoiding addictive substances like alcohol and drugs.
• Talking to your healthcare provider about any medications you’re taking that may increase your risk of developing rhabdomyolysis.

What can I expect if I have rhabdomyolysis?

If you have symptoms of rhabdomyolysis, you should see a healthcare provider right away. Rhabdomyolysis can be life-threatening. Early diagnosis and treatment are essential to your recovery.

What is the outlook for 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 can’t function.

You’ll be able to exercise again after your healthcare provider gives you the all-clear. Make sure you listen to your body and avoid overworking yourself or pushing yourself too hard.

When should I see a healthcare provider?

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

What questions should I ask my doctor?

• Do I need to stay in the hospital for treatment?
• How long until I’m able to return to exercising?
• How can I take care of my body during treatment?
• Did rhabdomyolysis cause complications in my kidneys?

A note from Cleveland Clinic

Rhabdomyolysis is a serious condition that can be life-threatening without treatment. If you notice signs or symptoms of the condition, visit a healthcare provider. You can reduce your risk of developing this condition when you’re exercising by listening to your body. If you’re tired, take a break. Don’t push yourself too hard. Stay hydrated and cool down your body if you’re working in warm temperatures. Your outcome will be more positive if you receive a diagnosis and treatment quickly.