From the Guidelines
Rhabdomyolysis is primarily caused by severe muscle damage, often resulting from trauma, crush injuries, extreme physical exertion, or certain medications, with the most recent evidence suggesting that novel overexertion is a leading cause of exertional rhabdomyolysis 1.
Causes of Rhabdomyolysis
The condition can be precipitated by various factors, including:
- Trauma or crush injuries, which can directly damage muscle cells, as seen in patients with severe limb trauma 1
- Extreme physical exertion, especially when it involves novel or unaccustomed activities, leading to excessive muscle strain 1
- Certain medications, such as statins (especially when combined with certain antibiotics or antifungals), antipsychotics, and some anesthetics, which can increase the risk of muscle damage 1
- Drug or alcohol abuse, which can lead to muscle damage through various mechanisms
- Genetic muscle disorders, which can predispose individuals to muscle damage and rhabdomyolysis
- Infections, heat stroke, seizures, and electrolyte abnormalities, which can also precipitate rhabdomyolysis
Prevention and Management
Preventing rhabdomyolysis, especially in athletes, involves gradual and calibrated increases in physical activity, avoiding novel overexertion, and ensuring proper hydration and electrolyte balance 1. Management of rhabdomyolysis typically involves aggressive IV fluid administration to prevent kidney damage, electrolyte monitoring and correction, and addressing the underlying cause. In severe cases, dialysis may be necessary to support kidney function until recovery.
Key Considerations
It is crucial to recognize the signs and symptoms of rhabdomyolysis, including muscle pain, weakness, and dark urine, and to seek immediate medical attention if these symptoms occur. Early recognition and treatment can significantly improve outcomes and reduce the risk of complications, such as acute kidney injury.
From the FDA Drug Label
Symptoms Manifestations of acute overdosage with amphetamines include ... rhabdomyolysis... Musculoskeletal Rhabdomyolysis
Rhabdomyolysis causes include amphetamine overdosage, as stated in the drug labels 2 and 2.
- Amphetamine use can lead to rhabdomyolysis, a serious condition characterized by muscle breakdown.
- The exact mechanism is not specified in the labels, but it is listed as a potential symptom of acute overdosage and an adverse reaction to amphetamine use.
From the Research
Causes of Rhabdomyolysis
Rhabdomyolysis, also known as rhabdo, is a serious syndrome that occurs when there is damage to the muscle cells, resulting in the release of muscle fiber contents into the blood. The causes of rhabdomyolysis can be divided into two main categories: traumatic and non-traumatic.
Traumatic Causes
Traumatic causes of rhabdomyolysis include:
- Physical trauma, such as crush injuries or severe blows to the muscle
- Extreme physical exertion, such as marathon running or other endurance activities
Non-Traumatic Causes
Non-traumatic causes of rhabdomyolysis include:
- Drug and substance abuse, such as:
- Medications, such as:
- Infections, such as viral or bacterial sepsis 5, 6
- Systemic diseases, such as arterial occlusion or systemic diseases 5
- Congenital conditions, such as glycogen storage disease, discrete mitochondrial myopathies, or muscular dystrophies 5
- Deficiency states, such as hypoxia or metabolic disorders 6
- Toxins or poisons, which can activate cytolytic enzymes or interfere with metabolism and disrupt the integrity of the skeletal muscle cell 6
Mechanisms of Rhabdomyolysis
The mechanisms of rhabdomyolysis involve a common final pathway that mediates cellular injury, including:
- Increased cellular permeability to sodium ions
- Accumulation of sodium ions in the cytoplasm of the cell
- Increase of cytosolic or mitochondrial calcium
- Activation of proteolytic enzymes that injure the cell membrane
- Release of cellular components into the circulation, including myoglobin and creatine kinase 6