From the Guidelines
Non-traumatic rhabdomyolysis is most commonly caused by medications, particularly statins, as well as other substances, metabolic disorders, infections, extreme exertion, and genetic muscle disorders, as supported by the most recent evidence from 1. The most frequent causes of non-traumatic rhabdomyolysis include:
- Medications and substances, such as statins, antipsychotics, antiretrovirals, colchicine, alcohol, and illicit drugs like cocaine and MDMA
- Metabolic disorders, including diabetic ketoacidosis and severe electrolyte abnormalities, particularly hypokalemia and hypophosphatemia
- Infections, such as influenza, HIV, legionella, and various viral myositis
- Extreme exertion, especially in untrained individuals or hot environments
- Prolonged immobility, as in coma, prolonged surgery, or drug overdose
- Endocrine disorders, including hypothyroidism and hyperthyroidism
- Autoimmune myopathies and genetic muscle disorders, such as McArdle disease and carnitine palmitoyltransferase deficiency
- Heat-related illness and neuroleptic malignant syndrome are also significant causes, as noted in 1. The pathophysiology of rhabdomyolysis involves damage to muscle cell membranes, leading to the release of intracellular contents, including creatine kinase, myoglobin, electrolytes, and other cellular components, into the bloodstream, which can cause acute kidney injury, electrolyte abnormalities, and compartment syndrome, as described in 1. Early recognition of these causes is essential for prompt treatment, which includes addressing the underlying etiology, aggressive fluid resuscitation, and monitoring for complications, as recommended in 1. It is crucial to evaluate the temporal sequence between medication administration and the onset of injury, as well as other possible causes, to determine the likelihood of medication-induced rhabdomyolysis, as suggested in 1. In patients with risk factors for rhabdomyolysis, such as high doses of statins, renal insufficiency, or concomitant use of gemfibrozil, careful monitoring and consideration of alternative treatments are necessary to minimize the risk of this potentially life-threatening condition, as noted in 1.
From the Research
Common Etiology of Non-Traumatic Rhabdomyolysis
- Non-traumatic rhabdomyolysis can be caused by various factors, including hypoxic, physical, chemical, or biological factors 2
- Congenital conditions such as glycogen storage disease, discrete mitochondrial myopathies, and various muscular dystrophies can also lead to non-traumatic rhabdomyolysis 3
- Acquired conditions like alcoholic myopathy, systemic diseases, arterial occlusion, viral illness, or bacterial sepsis can cause non-traumatic rhabdomyolysis 3
- Other causes of non-traumatic rhabdomyolysis include agitation, increased motor activity, and certain medication use, such as venlafaxine 4
- The four main etiological categories of rhabdomyolysis are traumatic, non-traumatic, non-traumatic exertional, and non-traumatic non-exertional 4
Key Factors Contributing to Non-Traumatic Rhabdomyolysis
- Muscle injury and necrosis can lead to the release of cell degradation products and intracellular elements into the bloodstream and extracellular space 2
- The percentage of patients with rhabdomyolysis who develop acute kidney injury varies from 13% to over 50% depending on the cause and clinical setting 2
- Elevated creatine kinase (CK) and myoglobin levels are biomarkers of muscle injury and can aid in the diagnosis and prognostication of non-traumatic rhabdomyolysis 2, 3