Rhabdo: Causes, Symptoms, and Diagnosis
Symptoms of Rhabdo
The symptoms of rhabdomyolysis are caused by the breakdown of muscle tissue. Muscle cells become damaged due to excessive amounts of acidity or alkalinity in your body. These acids or alkalis damage muscle fibers causing them to break down into smaller pieces called myofibrils (muscle fibers).
Myofibrils are small enough to pass through the blood-brain barrier and enter the brain. There they begin to break down further into their constituent parts. Eventually these individual proteins will form a gel which becomes fluid. This is known as rhabdomyolysis.
Symptom 1: Muscle Pain
Muscle pain may occur immediately after exercise or it may develop days later with no apparent reason. Some people experience only mild discomfort while others feel severe pain. The pain may be localized or generalized.
For example, you might have aching muscles in one area but not others. Other symptoms include numbness, tingling, weakness, dizziness and confusion.
Symptom 2: Abnormal Heart Rhythm
Some people report abnormal heart rhythms during the initial stages of rhabdomyolysis and some do not experience any problems afterwards. This may be due to the fact that the concentration of myoglobin in the blood increases greatly (about 15-fold) when muscles are damaged.
Symptom 3: Low Blood Pressure
Due to injured muscles, blood flow to the heart is decreased. This leads to low blood pressure and potentially fainting or dizziness. Many people experience this as one of the major symptoms of rhabdomyolysis.
Symptom 4: Severe Muscle Pain
The most discomforting symptom of rhabdomyolysis is the severe pain that you experience. While most people do not experience this, others report feeling severe muscle pains all over their body. This may be due to damage to muscles in areas such as the arms, legs and back.
It may also be due to a combination of factors including changes in blood pressure, low oxygen levels and even the build up of lactic acid.
What Are the Causes of Rhabdomyolysis?
There are four known causes of rhabdomyolysis: crush injuries, drugs and toxins, metabolic disorders and muscle trauma. Each has its own cause and unique factors that lead to the onset of this potentially life-threatening condition.
Crush injuries are caused by extreme pressure applied to muscles.
Drugs and toxins – these substances directly affect the muscles of the body.
Metabolic disorders – There are a number of rare metabolic disorders that directly affect the muscles and their ability to contract, relax and remain healthy. These may be inherited (passed down through families) or caused by a new genetic mutation.
Muscle trauma – Muscles become damaged as a result from over-exertion or trauma such as a car accident, fall or sports injury.
Who Gets Rhabdomyolysis?
Anyone can get rhabdomyolysis, however, certain individuals are at greater risk. Some of these groups include:
Infants and children – due to their smaller body size and inactive lifestyles they are at greater risk. Children are also at risk of getting this condition from muscle trauma such as a severe beating.
Older adults – as we age, our muscles naturally break down and become weaker. For some older people, even the most basic activities of daily life can lead to rhabdomyolysis.
People with illnesses or conditions – those who have conditions such as kidney disease, liver failure or severe anemia are at greater risk of developing this condition. Also, individuals with sickle cell anemia are at increased risk.
Drug addicts – several street drugs, including methamphetamine (crystal meth) may directly affect muscles and cause rhabdomyolysis.
What Complications Can Arise From Rhabdomyolysis?
Complications from rhabdomyolysis can vary in severity and include the following:
Death – due to extreme muscle breakdown toxins are released into the body that can cause kidney failure. This, in turn, may lead to death.
Muscle loss – since muscles are broken down during this process, muscle loss is common. This also impairs physical functioning and the ability to carry out day-to-day activities. In extreme cases, individuals may need help with basic functions such as walking, dressing and eating.
Muscle weakness – as muscles are broken down in this process they do not regenerate. This results in weakness that can be long-lasting and even permanent. In some cases, people may have trouble carrying out even the simplest of tasks.
Decreased quality of life – for some people, the weakness caused by this condition may be so severe that they are no longer able to work or carry out their normal activities of daily living. This can cause major changes in quality of life and even emotional issues such as depression.
How Is Rhabdomyolysis Diagnosed?
Your doctor will take a detailed medical history and perform a physical examination. He or she may ask about your medical history, where you have felt pain and whether you have had any specific injuries. Your doctor will also want to know about any prescription or over-the-counter medications you are taking.
A number of tests may be used to confirm a diagnosis of rhabdomyolysis:
Blood tests – a blood test can help your doctor determine if there is an underlying condition that is causing the rhabdomyolysis. Blood tests can also detect changes in kidney function and the presence of infection.
Muscle testing – your doctor may test the strength of your muscles to help determine how severe any damage is. He or she may also test your reflexes.
Skeletal X-rays – these can help rule out bone fractures, dislocations or infectious processes.
How Is Rhabdomyolysis Treated?
The underlying cause of the condition needs to be treated. For example, if the condition is due to severe muscle trauma following a car accident, then your injuries will need to be treated. If rhabdomyolysis is related to drug use (which is relatively rare), your doctor may recommend stopping the medication. Your doctor may also suggest that you stop taking certain medications that can contribute to the condition if those are the cause of the problem.
Severely affected individuals may need to be admitted to the hospital for intravenous (IV) fluids and the delivery of medications such as penicillin or diuretics.
Sometimes kidney dialysis is needed if the kidneys fail due to the effects of rhabdomyolysis.
Complications Without Treatment
Without treatment, complications can arise that may be life-threatening. These include:
Kidney failure – this can lead to fluid overload and an increased risk of death.
Amputation – in some cases of severe rhabdomyolysis, it may be necessary to amputate the affected limb to prevent the spread of toxins. This condition is called compartment syndrome.
Death – if the condition is not treated promptly, it may result in multisystem organ failure and eventually death.
Complications With Treatment
With treatment, complications are rare.
If you have been diagnosed with rhabdomyolysis, your doctor will closely monitor you for signs of complications.
With proper treatment, most people with rhabdomyolysis make a full recovery and experience no permanent effects. However, the condition can be fatal. If you experience any symptoms of rhabdomyolysis, see your doctor right away.
The earlier the condition is found and treated, the better the outlook.
Sources & references used in this article:
Rhabdomyolysis: pathogenesis, diagnosis, and treatment by PA Torres, JA Helmstetter, AM Kaye… – Ochsner Journal, 2015 – ochsnerjournal.org
Diagnostic evaluation of rhabdomyolysis by JR Nance, AL Mammen – Muscle & nerve, 2015 – Wiley Online Library
Acute pediatric rhabdomyolysis: causes and rates of renal failure by R Mannix, ML Tan, R Wright, M Baskin – Pediatrics, 2006 – Am Acad Pediatrics
Acute renal failure related to rhabdomyolysis: pathophysiology, diagnosis, and collaborative management. by TA Russell – Nephrology nursing journal, 2005 – search.ebscohost.com
Rhabdomyolysis: advances in diagnosis and treatment by R Parekh, D Caro, C Tainter – Emergency medicine practice, 2012 – insights.ovid.com
The other medical causes of rhabdomyolysis by RC Allison, DL Bedsole – The American journal of the medical sciences, 2003 – Elsevier