From the Guidelines
Rhabdomyolysis is a serious medical condition characterized by the breakdown of muscle tissue, leading to the release of muscle fibers and other cellular contents into the bloodstream, which can cause kidney damage and other complications.
Key Features of Rhabdomyolysis
- It is often associated with elevated creatine kinase (CK) levels, with levels above 10 times the upper limit of normal (ULN) indicating a high risk of rhabdomyolysis 1.
- Myoglobinuria, or the presence of myoglobin in the urine, is also a key feature of rhabdomyolysis, as myoglobin can cause kidney damage and obstruct kidney tubules 2.
- Rhabdomyolysis can be caused by a variety of factors, including trauma, overexertion, and certain medications, such as statins 1, 3.
- Early recognition and treatment are critical to preventing long-term kidney damage and other complications, with aggressive fluid resuscitation and monitoring of kidney function being key components of treatment 4, 2.
Diagnosis and Treatment
- Diagnosis is typically made based on a combination of clinical symptoms, such as muscle pain and weakness, and laboratory tests, including CK levels and urinalysis for myoglobinuria 1, 2.
- Treatment involves aggressive fluid resuscitation to help flush out myoglobin and other toxins from the kidneys, as well as monitoring of kidney function and electrolyte levels 4, 2.
- In some cases, dialysis may be necessary to support kidney function and remove waste products from the blood 4.
From the Research
Definition and Pathophysiology
- Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle, causing myoglobin and other intracellular proteins and electrolytes to leak into the circulation 5.
- The development of rhabdomyolysis is associated with a wide variety of diseases, injuries, medications, and toxins 5.
- Muscle damage can occur from direct injury or by metabolic inequalities between energy consumption and energy production 5.
Diagnosis
- Rhabdomyolysis is diagnosed by elevations in serum creatine phosphokinase (CPK) 5.
- A CK level at least 10 times the upper limit of normal is typically considered diagnostic, as is myoglobinuria 6.
- While there is no established serum level cut-off, many clinicians use five times the upper limit of normal (approximately 1000 U/l) 5.
Complications
- Rhabdomyolysis can be complicated by acute renal failure (occurring in 4%-33% of patients), compartment syndrome, cardiac dysrhythmias via electrolyte abnormalities, and disseminated intravascular coagulopathy 5.
- Acute kidney injury (AKI) is the most significant complication 6.
- Significant electrolyte abnormalities may be present and must be managed to avoid cardiac arrhythmias and arrest 6.
Treatment
- The mainstay of treatment is hospitalization with aggressive intravenous fluid (IVF) resuscitation with the correction/prevention of electrolyte abnormalities 5.
- Prompt recognition and management of rhabdomyolysis is crucial to preserving renal function 6.
- Management consists of rapidly initiating aggressive intravenous saline resuscitation to maintain a urine output of at least 300 mL/hour 6.
- Sodium bicarbonate can be used for patients who are acidotic, and mannitol can be used for those whose urine output is not at goal 6.
- Intravenous fluids typically are continued until CK levels are lower than 1,000 U/L 6.