What is Rhabdomyolysis?

From the Guidelines

Rhabdomyolysis is a serious medical condition characterized by muscle symptoms with marked creatine kinase (CK) elevation and creatinine elevation, often resulting in acute kidney injury.

Definition and Diagnosis

• Rhabdomyolysis is defined as muscle symptoms with CK elevation typically greater than 10 times the upper limit of normal (ULN) and with creatinine elevation, usually accompanied by brown urine and urinary myoglobin 1.
• The condition can be diagnosed by measuring CK levels, with values greater than 10 times the ULN indicating rhabdomyolysis 1.

Causes and Risk Factors

• Rhabdomyolysis can be caused by various factors, including severe limb trauma, crush injuries, and the use of certain medications such as statins 1.
• Patients with complex medical problems, those taking multiple medications, and those with predisposing comorbidities such as renal or liver disease are at higher risk of developing rhabdomyolysis 1.

Prevention and Treatment

• Early detection and treatment of rhabdomyolysis are crucial to prevent acute kidney injury and other complications 1.
• Treatment involves aggressive fluid resuscitation, with volumes greater than 6L required in patients with severe rhabdomyolysis to prevent acute kidney injury and the need for renal replacement therapy 1.
• The management of kidney injury resulting from rhabdomyolysis follows the same principles as the management of acute kidney injury in other contexts, with referral to established guidelines such as the French recommendations for acute kidney injury in the perioperative period and intensive care units 1.

From the Research

Definition of Rhabdomyolysis

• Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle, causing myoglobin and other intracellular proteins and electrolytes to leak into the circulation 2.
• It is a clinical condition characterized by destruction of skeletal muscle with release of intracellular contents into the bloodstream, including electrolytes, enzymes, and myoglobin 3.
• Rhabdomyolysis is a clinical syndrome in which the contents of injured muscle cells leak into the circulation, resulting in electrolyte abnormalities, acidosis, clotting disorders, hypovolemia, and acute renal failure 4.

Causes and Complications

• The development of rhabdomyolysis is associated with a wide variety of diseases, injuries, medications, and toxins 2.
• More than 100 conditions, both traumatic and non-traumatic, can lead to rhabdomyolysis 4.
• Rhabdomyolysis can be complicated by acute renal failure, compartment syndrome, cardiac dysrhythmias via electrolyte abnormalities, and disseminated intravascular coagulopathy 2.
• The systemic impact of rhabdomyolysis ranges from asymptomatic elevations in bloodstream muscle enzymes to life-threatening acute kidney injury and electrolyte abnormalities 3.

Diagnosis and Treatment

• Rhabdomyolysis is diagnosed by elevations in serum creatine phosphokinase (CPK), with many clinicians using five times the upper limit of normal as a cut-off 2.
• A CK level at least 10 times the upper limit of normal is typically considered diagnostic, as is myoglobinuria 5.
• The mainstay of treatment is hospitalization with aggressive intravenous fluid (IVF) resuscitation and correction/prevention of electrolyte abnormalities 2.
• Management consists of rapidly initiating aggressive intravenous saline resuscitation to maintain a urine output of at least 300 mL/hour, with additional therapies such as sodium bicarbonate and mannitol as needed 5.