What is it?
•A breakdown of muscle fibers caused by extreme overload to the muscles.
•Damage to muscle causes the release of muscle fiber (myoglobin – protein pigment) into the bloodstream.
•Myoglobin breakdown may cause severe kidney blockage and damage.
Causes
Skeletal muscle damage due to:
•Trauma: auto accident, fall, blast, crush
•Extreme physical exercise – abrupt increase
•Poor hydration
•Hypothermia, drowning
•Drug (cocaine)/alcohol + hyperthermia
•Medications: Statins (Zocor, Lipitor, Pravachol, Mevacor)
•Low electrolytes: potassium, phosphate, magnesium
Symptoms
•Muscle soreness, pain, tenderness, weakness
•Swelling
•Dark, cola or red colored urine
•Joint pain
•Fatigue, dizziness, nausea, vomiting
•Seizures
Complications
•Acute kidney failure
•Compartment syndrome
•Hyperkalemia
•Hyperphosphatemia
Risk Factors
•Genetics
•Abrupt increase in exercise, especially eccentric muscle contraction
•Being out-of-shape and beginning a hard exercise program
•Hot weather/heat stroke – heat intolerance
•NSAID use
•Diabetes
•Sickle Cell Disease
•Alcoholism
•Drug use – cocaine, steroids
Diagnosis
•Physical examination of muscles: tenderness, compartment syndrome
•Urinalysis – blood
•Blood work
◦Creatine phosphokinase
◦Electrolytes
◦Liver enzymes
◦Serum myoglobin
Treatment
Goal - Preserve kidney function and treat shock
•Fluids – oral rehydration, IV fluid
•Electrolyte replacement
•Discontinue toxic medication
Prognosis
•Favorable and reversible if treated promptly
•In severe compartment syndrome multiple surgeries may be necessary causing permanent damage to the muscle(s)
Prevention
•Avoid extreme exertion in the heat
•Gradual ramping up of fitness level: aerobic exercise and weight training
•Recovery nutrition: protein and hydration
•Pay attention to symptoms – get examined and treated!
•Buddy system between athletes when training/game
•Good communication between all parties: athletes, coaches and parents
For more information see:
Rhabdomyolysis in High School athlete
Rhabdomyolysis in Collegiate Athletes - Iowa
Exertional Heat Illness, Exertional Rhabdomyolysis, and Malignant Hyperthermia: Is There a Link?
Rhabdomyolysis in 119 students after repetitive exercise
