Rhabdomyolysis results from the toxicity of destroyed muscle cells, causing kidney damage or failure. It affects about 1 out of 10,000 people in the United States and has a slightly higher incidence in men. Rhabdomyolysis accounts for 8% to 15% of cases of acute renal failure; about 5% of cases result in death.
Rhabdomyolysis follows direct injury to the muscle fibers, specifically the sarcolemma, which then release myoglobin into the bloodstream. The myoglobin alters filtration in the kidneys, resulting in damage and failure.
Rhabdomyolysis may result from blunt trauma; extensive burn injury; viral, bacterial, or fungal infection (such as legionnaire’s disease or, especially, influenza type A or B); prolonged immobilization; near electrocution or near drowning; metabolic or genetic factors; drug therapy; or toxins. Heavy exercise in children may result in rhabdomyolysis. Other causes include shaken baby syndrome, exposure to extreme cold, heatstroke, and snakebite.
Risk factors include alcohol abuse, recent soft-tissue compression, and seizure activity.
Signs and symptoms of rhabdomyolysis include myalgias or muscle pain (especially in the thighs, calves, or lower back), weakness, tenderness, malaise, fever, dark urine, nausea, and vomiting. The patient may also experience weight gain, seizures, joint pain, and fatigue. Symptoms may be subtle initially and result in acute renal failure.
❑ Creatine kinase levels that are 100 times above normal or higher suggest rhabdomyolysis.
❑ Urine tests are positive for hemoglobin or myoglobin.
Early, aggressive hydration may prevent complications from rhabdomyolysis by rapidly eliminating myoglobin from the kidneys. I.V. hydration and diuretics promote diuresis. Bicarbonate may be administered to prevent myoglobin from breaking down into the toxic compounds in the kidney. Dialysis and, in severe cases, kidney transplantation may be necessary.
❑ Monitor intake and output, vital signs, electrolyte levels, daily weight, and laboratory results.
❑ Watch for signs of renal failure (such as decreasing urine output and increasing urine specific gravity), fluid overload (such as dyspnea and tachycardia), pulmonary edema, and electrolyte imbalances (such as serum potassium).
❑ Provide reassurance and emotional support for the patient and family.
❑ To help prevent rhabdomyolysis from occurring, ensure adequate hydration, monitor the patient for adverse reactions to any of his prescribed drugs, and monitor blood transfusion carefully.
❑ If the patient develops acute renal failure, provide care accordingly. (See “Renal Failure, Acute” pages 711 to 714.)
Review other book chapters online related to Rhabdomyolysis:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5 
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