From the Guidelines
Yes, a fall can cause rhabdomyolysis (rhabdo), a serious condition that occurs when damaged muscle tissue releases proteins and electrolytes into the bloodstream, potentially causing kidney damage. Falls, especially those resulting in significant impact or crushing injuries, can cause muscle trauma that leads to rhabdo, as evidenced by guidelines for the acute care of severe limb trauma patients 1. The risk increases if you remain immobile on the ground for an extended period after falling. Symptoms to watch for include severe muscle pain, weakness, dark urine (tea or cola-colored), and decreased urination.
According to recent guidelines, raising CPK levels above five times normal (approximately 1000 IU/L) is a sign of rhabdomyolysis, and myoglobin is responsible for intraluminal kidney tubular obstruction resulting in reduced glomerular filtration rate 1. In some studies, it appears that the measurement of plasma myoglobin may be more sensitive and specific than CPKs in identifying the risk of acute kidney injury, which is correlated with increased mortality.
To detect acute kidney injury in patients suffering from post-traumatic acute rhabdomyolysis after limb traumatic injury, it is probably recommended to perform a repeated bio-assessment combining plasma myoglobin, plasma creatine phosphokinase (CPK) and kalaemia measurements, as well as bladder catheterisation to monitor hourly urine output and urine pH, which should be maintained at 6.5 1. If you suspect rhabdo after a fall, seek immediate medical attention, as treatment typically involves aggressive IV fluid administration to prevent kidney damage, with hospitalization usually required for monitoring and management. Elderly individuals, those taking certain medications (like statins), and people with underlying medical conditions may be at higher risk for developing rhabdo after trauma.
From the Research
Causes of Rhabdomyolysis
- Rhabdomyolysis can be caused by various factors, including crush injuries, prolonged immobilization, seizures, severe infections, and drug toxicity 2, 3, 4, 5
- Trauma, including falls, can also lead to rhabdomyolysis, as evidenced by a case study of a person who developed rhabdomyolysis and acute kidney injury after a fall at home 6
- Other potential causes of rhabdomyolysis include exertion, extreme temperature changes, ischemia, infections, immobility, drugs, toxins, endocrine causes, autoimmune reactions, and genetic conditions 4
Diagnosis and Treatment of Rhabdomyolysis
- The diagnosis of rhabdomyolysis is typically established by elevation of serum muscle enzymes and muscle constituents, such as creatinine phosphokinase and myoglobin 2, 3, 4
- Treatment of rhabdomyolysis includes addressing the underlying cause, aggressive intravenous hydration, and management of electrolyte imbalances and acute kidney injury 3, 4, 6
- Early recognition and treatment of rhabdomyolysis are crucial to prevent severe complications, such as acute renal failure and multi-organ failure 2, 3, 4, 6