Rhabdomyolysis, a condition that destroys skeletal muscle, could cause kidney damage, muscle injury, muscle weakness, and abdominal pain.
Pronounced rab-doe-my-o-lie-sis, this skeletal muscle problem can result in leakage of the muscle protein myoglobin into the urine.
Our bodies consist of smooth muscle, heart muscle, and skeletal muscle. All have important functions, but it is the skeletal muscle that is affected by rhabdomyolysis. The skeletal muscle is important to our overall health. It helps maintain our posture, produces motion, and assists the respiratory muscles when it comes to ventilating the lungs. The skeletal muscles also contribute to metabolic control and oxidizing fatty acids, which help control blood glucose and lipid levels.
If a person has rhabdomyolysis, myoglobin protein – a compound of muscle cells – has likely been released into the blood. Thus, a blood test can tell doctors that skeletal muscle is destroyed by the disease. The measurement of myoglobin along with another protein called creatine kinase can help determine the degree of muscle injury.
Rhabdomyolysis causes and triggers
Rhabdomyolysis causes are always linked in some way to an injury. That injury might be due to a physical situation, such as being crushed by weight or being starved by a blocked blood vessel. It could also be a chemical cause, like toxins, drugs, or heat.
As described above, when the muscle is damaged it means that myoglobin has been released into the blood. It is filtered out of the body via the kidneys. The problem is, myoglobin is toxic and high levels of this protein can lead to kidney damage.
It may sound hard to believe, but really intense exercise, heatstroke, and third-degree burns can cause rhabdomyolysis. Below are some other potential causes.
- Lightning strike
- Marathon running
- Pathological muscle exertion
- Ischemic limb injury
- Intense shivering
- Genetic and metabolic disorders (i.e., hypothyroidism, Duchenne muscular dystrophy, McArdle’s disease, carnitine deficiency, diabetic ketoacidosis)
- Infection and inflammation (i.e., viral infection, bacterial infection, snakebites, polymyositis)
- Medications and toxins (i.e., statins, cocaine, LSD, ecstasy, cyclosporine, erythromycin, colchicine, amphetamines)
There are many other causes of rhabdomyolysis, but these are the most widely known. Essentially, anything that causes damage to the muscle can cause this condition.
Rhabdomyolysis signs and symptoms
With so many possible causes, you might be wondering, how will I know if I get rhabdomyolysis? The most common rhabdomyolysis symptoms include, muscle weakness, muscle aches, abdominal pain, and dark urine. The muscle damage created by the condition can cause inflammation, which leads to swelling, weakness, and pain. The dark urine is due to the fact that myoglobin is being dispelled in the urine. Some people think they have blood in their urine, but with rhabdomyolysis, normally no red blood cells are detected in urine under a microscope.
Serious complications can arise, such as kidney failure, decreased urine production, fluid in the lungs, shortness of breath, and palpitations due to heart rhythm problems. For some reason, many people with rhabdomyolysis experience very high levels of potassium in the blood, which can lead to an irregular heartbeat or cardiac arrest. It can also cause kidney damage – something that seems to happen in half of patients with the condition. Research shows that one in four develop problems with their liver. Hepatic inflammation or swelling of the liver can lead to liver damage, as well as other problems, when it comes to filtering toxins from the blood.
A condition called “compartment syndrome” can also happen after fluid resuscitation. This is a serious compression of the nerves, blood vessels, and muscles that can lead to tissue damage and blood flow problems.
Complications can occur in the early or late stages of rhabdomyolysis.
Rhabdomyolysis from statin use
Some mild pain is not unusual when you are using statins. However, some people who take statins have experienced severe muscle pain. There is a possibility that this intense pain could be rhabdomyolysis.
Research suggests that the higher the dose of statins, the higher the risk a person has of getting rhabdomyolysis. It is important to also know that your risk increases if statins are taken alongside certain medications. Those medications include cyclosporine (Sandimmune) and gemfibrozil (Lopid). Experts say that the risk of developing rhabdomyolysis from simple statin therapy is relatively low.
If you are taking statins and notice moderate or severe muscle pain, do not suddenly stop taking your statin medication, but see a doctor for a proper assessment.
Rhabdomyolysis treatment and prevention
Medical history shows that early diagnosis and treatment leads to the best outcome for those with rhabdomyolysis. With quick and proper treatment, there is no reason not to expect a full recovery.
Once rhabdomyolysis is diagnosed, it can be addressed by pinpointing the cause. For example, a possible treatment option will mean discontinuing a toxic medication, replacing electrolytes, or maybe addressing an underlying muscle disease.
Mild cases can be taken care of in the comfort of a person’s own home. In more severe cases, a person will have to be admitted to a hospital. Intravenous fluids may be used, nutrients will likely be monitored, and depending on the cause of the rhabdomyolysis, surgery may be performed. One example of a surgical procedure is a fasciotomy. This operation relieves pressure and loss of circulation if compartment syndrome is threatening to destroy muscle. It is rare, but in some situations, dialysis treatment may be required to help a person’s kidneys filter waste as they recover.
When it comes to prevention, consider exercise programs – sometimes we can push ourselves too hard. Exercise routines should be carefully thought out to help us avoid rhabdomyolysis. For instance, don’t exercise in extreme heat conditions and remember to drink plenty of fluid when working out. It is also a big no-no to work out when you are drinking alcohol, taking strong medications, or when you are ill.
Many nutritionists and top athletes believe that sufficient sleep, a balanced diet that is rich in vitamins and minerals, along with plenty of water are excellent preventative measures when it comes to our muscle health.
Muscle pain is common, and while sometimes it can last longer than we expect, we should not panic and assume it is rhabdomyolysis. Still, when experiencing uncomfortable, persistent muscle pain, it would be wise to review the symptoms outlined here and get a thorough physical examination from a qualified medical expert.