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Diseases

Rhabdomyolysis

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

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Key Highlights
  • Rhabdomyolysis is the end result of any disease process that causes muscle cell (myocyte) lysis.

  • May have an obvious presentation, such as traumatic "crush" injury, or may be insidious, requiring a high clinical index of suspicion.

  • Muscular pain or discomfort is common, but rhabdomyolysis can have no symptoms or physical signs.

  • Diagnosis is confirmed by elevated serum creatine kinase level.

  • Fluid hydration is the mainstay of therapy.

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

        More information...
      • Diagnostics Tests

          More information...
        • Treatment Options

            More information...

          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Citations

            Key Articles

            • Kodadek L, Carmichael Ii SP, Seshadri A, et al. Rhabdomyolysis: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document. Trauma Surg Acute Care Open. 2022;7(1):e000836.[Abstract][Full Text]

            • The Renal Association (UK). Clinical practice guideline: acute kidney injury (AKI). Aug 2019 [internet publication].[Full Text]

            • Sawhney JS, Kasotakis G, Goldenberg A, et al. Management of rhabdomyolysis: a practice management guideline from the Eastern Association for the Surgery of Trauma. Am J Surg. 2022 Jul;224(1 pt a):196-204.[Abstract][Full Text]

            Other Online Resources

            • BAPEN: British consensus guidelines on intravenous fluid therapy for adult surgical patients

            Referenced Articles

            • 1. Poels PJ, Gabreels FJ. Rhabdomyolysis: a review of the literature. Clin Neuro Neurosurg. 1993 Sep;95(3):175-92.[Abstract]

            • 2. Kodadek L, Carmichael Ii SP, Seshadri A, et al. Rhabdomyolysis: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document. Trauma Surg Acute Care Open. 2022;7(1):e000836.[Abstract][Full Text]

            • 3. Gabow PA, Kaehny WD, Kelleher SP. The spectrum of rhabdomyolysis. Medicine (Baltimore). 1982 May;61(3):141-52.[Abstract]

            • 4. Brown CV, Rhee P, Chan L, et al. Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference? J Trauma. 2004 Jun;56(6):1191-6.[Abstract]

            • 5. Allison RC, Bedsole DL. The other medical causes of rhabdomyolysis. Am J Med Sci. 2003 Aug;326(2):79-88.[Abstract]

            • 6. Curry S, Chang D, Connor D. Drug- and toxin-induced rhabdomyolysis. Ann Emerg Med. 1989 Oct;18(10):1068-84.[Abstract]

            • 7. Welch R, Todd K, Krause G. Incidence of cocaine-associated rhabdomyolysis. Ann Emerg Med. 1991 Feb;20(2):154-7.[Abstract]

            • 8. Huynh T, Cordato D, Yang F, et al. HMG CoA reductase-inhibitor-related myopathy and the influence of drug interactions. Intern Med J. 2002 Sep-Oct;32(9-10):486-90.[Abstract]

            • 9. Antons K, Williams C, Baker S, et al. Clinical perspectives of statin-induced rhabdomyolysis. Am J Med. 2006 May;119(5):400-9.[Abstract]

            • 10. Labat V, Arnaud M, Miremont-Salamé G, et al. Risk of myopathy associated with DPP-4 inhibitors in combination with statins: a disproportionality analysis using data from the WHO and French spontaneous reporting databases. Diabetes Care. 2017 Mar;40(3):e27-9.[Abstract][Full Text]

            • 11. Patel C, Thompson C, Copley-Harris M, et al. Sitagliptin and simvastatin interaction causing rhabdomyolysis and AKI. Case Rep Med. 2019 Feb 26;2019:2601537.[Abstract][Full Text]

            • 12. Scroggie DA, Harris M, Sakai L. Rhabdomyolysis associated with nutritional supplement use. J Clin Rheumatol. 2000 Dec;6(6):328-32.[Abstract]

            • 13. Packard K, Price P, Hanson A. Antipsychotic use and the risk of rhabdomyolysis. J Pharm Pract. 2014 Oct;27(5):501-12.[Abstract]

            • 14. Star K, Iessa N, Almandil NB, et al. Rhabdomyolysis reported for children and adolescents treated with antipsychotic medicines: a case series analysis. J Child Adolesc Psychopharmacol. 2012 Dec;22(6):440-51.[Abstract]

            • 15. Pasternak RC, Smith SC Jr, Bairey-Merz CN, et al. ACC/AHA/NHLBI Clinical Advisory on the Use and Safety of Statins. Stroke. 2002 Sep;33(9):2337-41.[Abstract][Full Text]

            • 16. Samura M, Takada K, Hirose N, et al. Incidence of elevated creatine phosphokinase between daptomycin alone and concomitant daptomycin and statins: a systematic review and meta-analysis. Br J Clin Pharmacol. 2022 May;88(5):1985-98.[Abstract]

            • 17. Dalugama C, Pathirage M, Kularatne SAM. Delayed presentation of severe rhabdomyolysis leading to acute kidney injury following atorvastatin-gemfibrozil combination therapy: a case report. J Med Case Rep. 2018 May 22;12(1):143.[Abstract][Full Text]

            • 18. Amend KL, Landon J, Thyagarajan V, et al. Incidence of hospitalized rhabdomyolysis with statin and fibrate use in an insured US population. Ann Pharmacother. 2011 Oct;45(10):1230-9.[Abstract]

            • 19. Shi Y-LHX. Exertional rhabdomyolysis. J Clin Rehabil Tissue Eng Res. 2007;11:1123-6.

            • 20. Nye NS, Kasper K, Madsen CM, et al. Clinical practice guidelines for exertional rhabdomyolysis: a military medicine perspective. Curr Sports Med Rep. 2021 Mar 1;20(3):169-78.[Abstract][Full Text]

            • 21. Kagen L. Myoglobinemia in inflammatory myopathies. JAMA. 1977 May;237(3):1448-52.[Abstract]

            • 22. Bank W, DiMauro S, Bonilla E, et al. A disorder of muscle lipid metabolism and myoglobinuria. N Engl J Med. 1975 Feb 27;292(9):443-9.[Abstract]

            • 23. Singh U, Scheld W. Infectious etiologies of rhabdomyolysis: three case reports and review. Clin Inf Dis. 1996 Apr;22(4):642-9.[Abstract]

            • 24. Visweswaran P, Guntupalli J. Environmental emergencies. Crit Care Clin. 1999 Apr;15(2):415-28;ix-x.[Abstract]

            • 25. Line R, Rust G. Acute exertional rhabdomyolysis. Am Fam Physician. 1995 Aug;52(2):502-6.[Abstract]

            • 26. Weibrecht K, Dayno M, Darling C, et al. Liver aminotransferases are elevated with rhabdomyolysis in the absence of significant liver injury. J Med Toxicol. 2010 Sep;6(3):294-300.[Abstract][Full Text]

            • 27. Zutt R, van der Kooi AJ, Linthorst GE, et al. Rhabdomyolysis: review of the literature. Neuromuscul Disord. 2014 Aug;24(8):651-9.[Abstract]

            • 28. Nance JR, Mammen AL. Diagnostic evaluation of rhabdomyolysis. Muscle Nerve. 2015 Jun;51(6):793-810.[Abstract][Full Text]

            • 29. McMahon GM, Zeng X, Waikar SS. A risk prediction score for kidney failure or mortality in rhabdomyolysis. JAMA Intern Med. 2013 Oct 28;173(19):1821-8.[Abstract][Full Text]

            • 30. Foot CL, Fraser JF. Uroscopic rainbow: modern matula medicine. Postgrad Med J. 2006 Feb;82(964):126-9.[Abstract]

            • 31. The Renal Association (UK). Clinical practice guideline: acute kidney injury (AKI). Aug 2019 [internet publication].[Full Text]

            • 32. Sawhney JS, Kasotakis G, Goldenberg A, et al. Management of rhabdomyolysis: a practice management guideline from the Eastern Association for the Surgery of Trauma. Am J Surg. 2022 Jul;224(1 pt a):196-204.[Abstract][Full Text]

            • 33. Scharman EJ, Troutman WG. Prevention of kidney injury following rhabdomyolysis: a systematic review. Ann Pharmacother. 2013 Jan;47(1):90-105.[Abstract]

            • 34. Heppenstall R, Spega A, Scott R, et al. The compartment syndrome: an experimental and clinical study of muscular energy metabolism using phosphorus nuclear magnetic resonance spectroscopy. Clin Orthop Relat Res. 1988 Jan;(226):138-55.[Abstract]

            • 35. Braun S, Weiss F, Keller A, et al. Evaluation of the renal toxicity of heme proteins and their derivatives: a role in the genesis of acute tubular necrosis. J Exp Med. 1970 Mar 1;131(3):443-60.[Abstract]

            • 36. Shapiro ML, Baldea A, Luchette FA. Rhabdomyolysis in the intensive care unit. J Intensive Care Med. 2012 Nov-Dec;27(6):335-42.[Abstract]

            • 37. Block C, Manning H. Prevention of acute renal failure in the critically ill. Am J Respir Crit Care Med. 2002;165:320-324.[Abstract]

            • 38. Russell T. Acute renal failure related to rhabdomyolysis: pathophysiology, diagnosis, and collaborative management. J Nephrol Nurs. 2005 Jul-Aug;32(4):409-17.[Abstract]

            • 39. Karajala V, Mansour W, Kellum JA. Diuretics in acute kidney injury. Minerva Anestesiol. 2009 May;75(5):251-7.[Abstract]

            • 40. Huerta-Alardín AL, Varon J, Marik PE. Bench-to-bedside review: Rhabdomyolysis - an overview for clinicians. Crit Care. 2005 Apr;9(2):158-69.[Abstract][Full Text]

            • 41. Woodrow G, Brownjohn A, Turney J. The clinical and biochemical features of acute renal failure due to rhabdomyolysis. Ren Fail. 1995 Jan;17(1):467-74.[Abstract]

            • 42. The Sydney Children's Hospital Network. Acute rhabdomyolysis - investigation and management practice guideline. Feb 2021 [internet publication].[Full Text]

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