Updated: 9/29/23
Do you ever worry how pushing your body to its limits during an intense workout might lead to unexpected health risks? Unfortunately, these risks are real and can strike suddenly with no warning. Rhabdomyolysis is a serious medical condition that can affect those who push themselves too hard in the gym. Although symptoms can be mild or severe, this potentially life-threatening condition requires early identification and immediate treatment. In this article, we will discuss the common causes of rhabdomyolysis, its symptoms and potential treatments so that you can gain better understanding of how best to protect yourself from experiencing it.
What is Rhabdomyolysis Disease?
Rhabdomyolysis is a medical condition that can lead to serious health complications. It is a rare but potentially life-threatening condition that affects the muscles. If left untreated, it can cause death. Rhabdo is a serious condition characterized by the breakdown of muscle fibers, which releases a protein called myoglobin into the bloodstream. This can cause kidney damage, and in severe cases, kidney failure. This condition can occur due to several reasons, including muscle injury, overexertion, medication, or severe dehydration. As a health-conscious person, you need to educate yourself about rhabdomyolysis to recognize its early signs, seek prompt treatment, and avoid severe complications.
Rhabdomyolysis, or rhabdo for short, occurs when damaged muscles begin to break down and discharge contents of muscle fiber into the bloodstream. The condition is quite rare, with only around 26,000 cases reported every year in America. Men are at a slightly greater risk of getting rhabdomyolysis than women.
Athletes who train too hard are at great risk of developing rhabdo. When exercise is too intense, the muscles might not receive adequate oxygen and will begin to swell, break down and then burst. The breakdown of muscles releases proteins that may potentially damage the kidneys.
In addition to overexertion, other potential rhabdo causes include crush injuries, drug use, certain medications, seizures and severe dehydration.
Complications of Rhabdomyolysis
Roughly 85 percent of people with traumatic injuries get rhabdomyolysis, and 10-50 percent of those people will get acute renal failure. It’s also believed that people with severe injury who get rhabdomyolysis and severe renal failure later on have a 20 percent mortality rate.
The complications of rhabdomyolysis are determined by severity and several individual factors. Less serious cases hardly cause any obvious symptoms and may only be detected through blood serum tests. However, severe cases often lead to severe muscle pain and may be life-threatening.
Symptoms of Rhabdomyolysis
Symptoms of rhabdomyolysis can include:
- Muscle tenderness
- Muscle aching (myalgia) or stiffness
- General weakness
- Reduced urine output
- Red or dark-colored urine
- Weakness of affected muscles
- Seizures
- Joint pain
- Fatigue
- Unintentional weight gain
Causes of Rhabdomyolysis
When muscle damage occurs, myoglobin protein is releases into your blood. The kidneys then filter it from the body. Myoglobin disintegrates into substances that may destroy kidney cells.
Rhabdomyolysis may result from injury or any condition that destroys skeletal muscle. Factors that may contribute to rhabdo include:
Strenuous Muscle Exercise
One of the most common causes of rhabdomyolysis is excessive exercise or physical activity. Individuals who engage in high-intensity workouts, such as heavy weightlifting or long-distance running, are at risk of developing rhabdomyolysis. This is because intense exercise can cause muscle damage, leading to the release of harmful toxins into the bloodstream.
Muscle tissue destruction may result from strenuous muscle exercise, particularly in people exercising under severely humid or hot conditions or in untrained athletes. To avoid rhabdomyolysis, it is important to gradually increase the intensity of your workouts and to avoid pushing yourself too hard too quickly.
Muscle necrosis more commonly happens after walking downhill than after climbing uphill. The combination of hypoxemia, corticosteroid-induced muscle disease and muscular exertion may cause muscle tissue destruction in people with status asthmaticus.
Occlusion of Muscular Vessels
Embolism may also cause muscle necrosis if there’s prolonged deprivation of oxygen. Acute renal failure happens only if a vital muscle mass has turned necrotic, such as during generalized shock, after various diffuse emboli or after complete vascular occlusion involving one or more limbs.
Trauma and Compression
Rhabdomyolysis can also occur as a result of trauma or crush injury. A severe car accident, for example, can cause muscles to break down and release myoglobin into the bloodstream. Limb compression, such as that seen in a prolonged surgery or a person who becomes trapped in a collapsed building, can also lead to rhabdo. Muscle compression may also be caused by abuse, torture or longstanding confinement in one position — think surgical procedures requiring certain positions for prolonged periods, coma, psychiatric conditions and orthopedic problems.
Hyperthermia
Excessive body temperature can cause muscle damage. Neuroleptic malignant syndrome is one trigger for hyperthermia-induced rhabdomyolysis. It’s characterized by severe fever in people treated with haloperidol or phenothiazides.
Malignant hyperthermia is another possible cause — an inherited disorder that’s characterized by a swift increase in body temperature, usually after anesthesia with succinycholine or halogenated hydrocarbons. Due to excessive sweating, people with malignant hyperthermia also often have hypokalemia, which can worsen damage to muscles.
Infections
Some bacterial and viral infections can cause muscle breakdown and rhabdomyolysis. Infections that are famous to cause rhabdomyolysis include flu, pneumonia, and HIV. ‘Pyomyositis (locally invasive muscle infection), diffuse metastatic muscle infection during septicemia, and microbe infection-induced toxic shock syndrome can cause extensive muscle necrosis.
Electrical Current
Lightning strikes and high-voltage electrical injury cause rhabdomyolysis in around 10 percent of people surviving the original accident, even if they have small wounds at the point of entry.
Muscle tissue destruction is caused by sarcolemmal membrane disruption or thermal injury. The former leads to pore formation, barrier dysfunction and colossal calcium influx.
Underlying Medical Conditions
In some cases, underlying medical conditions such as genetic muscle disorders or viral infections can lead to rhabdomyolysis. Individuals with metabolic disorders or kidney disease are more susceptible to developing the condition. Certain genetic disorders such as McArdle’s disease and carnitine palmitoyltransferase deficiency also increase the risk of rhabdo, as these conditions interfere with the body’s ability to produce and use energy for muscle function.
Drugs and Toxins
Perhaps the most common cause of drug-related rhabdomyolysis these days is the use of medications known as HMG-CoA reductase inhibitors. These drugs must be withdrawn immediately if the patient complains of muscle issues or if cytokeratin levels rise to over three times above regular levels.
Simultaneous administration of itraconazole, erythromycin, cyclosporine, nicotinic acid or danazol increases the risk of drug-related muscle disease. The combination of gemfibrozil with HMG-CoA reductase inhibitors also increases the risk for muscle cell damage.
Cholesterol-lowering drugs alone can cause muscle cell damage, particularly in individuals with renal failure, as most cholesterol-lowering drugs build up when kidney efficiency reduces.
In people with chronic or acute alcohol intoxication, muscle damage is caused by a combination of direct muscle cell damage, immobilization, hypophosphatemia, hypokalemia or agitation.
Rhabdomyolysis due to toxin exposure is noticed not only after quail intake, but also after eating certain species of fish (Haff disease), or after coming into contact with various insect and snake venoms (for example, spiders and hornets).
Metabolic Causes
Exceptional rhabdomyolysis cases are inherited conditions that are all characterized by failure to deliver energy to muscles due to defects in nucleoside, glucose, lipid or glycogen metabolism. These conditions usually originate in childhood and may be present if myoglobinuria or muscle weakness recur frequently, or occur alongside events that may not cause rhabdomyolysis in healthy individuals.
Most often, the last common route leading to disintegration of muscles is poor delivery of ATP (adenosine triphosphate), which makes it impossible to maintain cell integrity. Viral infection, fasting and exertion are aggravating factors.
Electrolyte Abnormalities
Electrolyte imbalances, particularly low levels of potassium, magnesium, or phosphorus in the blood, can also cause rhabdomyolysis. This is because these minerals are necessary for proper muscle function, and a deficiency can lead to muscle damage.
Hypocalcemia, hypokalemia, hyponatremia, hypophosphatemia and especially hyperosmotic and hypernatremia disorders have all been linked to rhabdomyolysis.
Alcohol-induced muscle cell damage associates with electrolyte abnormalities, but severe illness and malnutrition can also cause electrolyte issues that cause rhabdo. Hypophosphatemia and hypokalemia disappear after renal failure and myonecrosis have occurred.
Living with Rhabdomyolysis
Living with rhabdomyolysis can be challenging, but it is possible by adopting a healthy lifestyle. Regular exercise, proper nutrition, and managing stress levels are key to leading a fulfilling life with this condition. With the help of a healthcare team, you can maintain your health through regular tests and monitoring.
Rhabdomyolysis symptoms warrant a visit to the emergency room and should be dealt with urgently. Even people with symptoms that don’t include cola-colored “brown pee” might have rhabdomyolysis.
But the good news is that quick diagnosis and treatment (often involving higher IV fluid levels) can often return the body to balance without lasting damage.
Rhabdomyolysis complications may be extremely serious and even fatal, so proper identification and prevention of symptoms is vital. Common “early” complications include severe hyperkalemia, which may lead to a cardiac arrest. The most severe “late” complication is acute renal failure. It affects around 15 percent of rhabdomyolysis patients.
Rhabdomyolysis Diagnosis
When you visit a doctor with symptoms that could indicate rhabdomyolysis, the first step in the diagnostic process will be a physical examination. The doctor will look for signs of muscle weakness, swelling, and tenderness in specific muscle groups. They may also check your urine for the presence of myoglobin, a protein that releases when muscle tissue receives damage. A positive myoglobin test is a strong indicator of rhabdomyolysis.
Labs for Rhabdomyolysis
Recognizing its symptoms early on can help prevent further complications and promote quick recovery. One of the ways to detect this condition is through certain laboratory tests that can identify key markers of rhabdomyolysis in the body.
Creatine Kinase Test
Creatine kinase is an enzyme released by damaged muscles, and higher levels of this enzyme in the blood can suggest rhabdomyolysis. A simple blood test called CK or creatine kinase test can help identify the levels of the CK enzyme in the blood. A higher-than-normal CK level, along with other symptoms like muscle pain, weakness, and tea-colored urine, can indicate rhabdomyolysis.
Liver Function Test
As the muscles break down, they release myoglobin, which can damage the kidneys and liver. A liver function test is a blood test that can determine the levels of liver enzymes like ALT, AST, and ALP, which can suggest liver injury. Elevated levels of these enzymes can indicate muscle breakdown and rhabdomyolysis.
Urine Analysis
A urine test can reveal the presence of myoglobin in the urine, which is a clear indicator of rhabdomyolysis. Dark, tea-colored urine can also suggest the presence of myoglobin in the urine.
Electrolyte Panel
Rhabdomyolysis can lead to the imbalance of electrolytes in the body, particularly potassium, calcium, and phosphate. An electrolyte panel can determine the levels of these electrolytes in the blood and help identify any imbalances that may need treatment.
Blood Gas Analysis
Severe cases of rhabdomyolysis can lead to metabolic acidosis, a condition in which the body produces too much acid. A blood gas analysis can measure the levels of bicarbonate and pH in the blood, which can indicate acidosis.
Treatment for Rhabdomyolysis up-to-date
Fluid Replacement
The first step in treating rhabdomyolysis is to ensure proper fluid replacement. When the muscles break down, they release myoglobin into the bloodstream, which can cause severe damage to the kidneys. Drinking a lot of fluids like water and electrolyte-rich drinks is essential to flush out the myoglobin from the bloodstream. You may also need to hospitalize for intravenous (IV) fluids to ensure adequate hydration.
Medications
The use of medications is another step to prevent further complications. Besides, prescription medication like allopurinol or sodium bicarbonate may help to prevent kidney damage or other complications. Pain management is also an essential part of the treatment for rhabdomyolysis. Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen may help alleviate the pain and control inflammation. In certain cases, opioid analgesics is a requirement.
Physical Therapy
In cases where rhabdomyolysis is from physical exertion, such as extreme exercise or a long period of immobilization, to receive physical therapy as a treatment option. Physical therapy can help to rebuild damaged muscle tissue and improve mobility.
Hospitalization
For some cases of rhabdomyolysis, admission to the hospital may be required for management. This is usually the case when the patient has high levels of creatine kinase in their blood. Treatment in the hospital will involve a range of measures aimed at managing your symptoms and preventing further damage. This may include the use of intravenous fluids to help flush out your kidneys and the administration of certain medications to help manage muscle pain.
Dialysis
Rhabdomyolysis treatment depends on how severe the symptoms are, and the presence of further health complications that can raise the likelihood of kidney injury. In serious cases, damage to the kidney can be irreversible if not treated early. In severe cases, your doctor may recommend dialysis to remove excess wastes and toxins from your body. If the kidneys receive critical damage, this treatment improve kidney function and prevent kidney failure. The process usually takes a few hours, and you may need to repeat the process as required.
Rest and Rehabilitation
Once discharged, you are not completely out of the woods yet. You will need to take some time to rest and rehabilitate as your muscles recover. It means avoiding strenuous activities like weightlifting and running until your doctor says its safe. Using heat treatment techniques like ice-cold compresses can help reduce muscle pain and improve mobility and flexibility.
Follow-up Appointments
After diagnosis, you will need to schedule follow-up appointments regularly. Do not skip any visit to the hospital as it will help your doctor monitor the condition and ensure that the treatment is working effectively. The appointments may also involve blood tests to check for any sign of the condition.
In all cases of suspected rhabdomyolysis, avoiding acute kidney injury is the most important goal of treatment.
Supplements for Kidney Health
Our kidneys play a crucial role in our overall health and well-being, from filtering toxins and waste products to regulating blood pressure and maintaining electrolyte balance. It is important to take good care of them, and one way to do so is by incorporating supplements in your diet. We will be discussing the top supplements for kidney health that are herbal, vitamin, and mineral-based. Whether you have kidney disease or simply want to support your kidneys, these supplements can help you maintain optimal kidney health.
Coenzyme Q10
Supplementing with Coenzyme Q10 (CoQ10) has been shown to protect the kidneys from oxidative damage. CoQ10 is an antioxidant that is involved in energy production and has been shown to improve kidney function in people with kidney disease.
Dandelion Tea
Dandelion has long time been an effective natural diuretic as the tea reduces water retention by encouraging urination. In fact, a pilot study of 17 subjects found that dandelion increased the volume and frequency of peeing for up to five hours.
The recommended dose for dandelion is 1,000 mg, taken twice a day or as otherwise advised by a doctor.
Magnesium
Magnesium plays a vital role in maintaining kidney functions. It balances electrolytes, regulates blood pressure, and prevents the formation of kidney stones. However, people with kidney problems may have low levels of magnesium. In such cases, it is essential to take Magnesium supplements to maintain proper kidney health.
Marshmallow Root
Marshmallow contains diuretic qualities, which help increase urination. This helps your body cleanse the bladder and kidneys to decrease mineral and toxin deposits.
Natural diuretics can also help decrease water retention — a very common bloating problem in many people, especially women.
The recommended dose for marshmallow root extract is 1,200 mg, taken 1-2 times daily.
Juniper
Juniper berry is a highly rated kidney tonic. Its oil extract has a diuretic effect, which promotes urination. It helps decrease water retention (edema) and lower blood pressure. The oil also has antiseptic properties.
Talk to your physician about the right juniper berry extract serving size for you.
Parsley
A 2002 study showed that parsley extract powder is packed with vitamins and antioxidants that can help to flush the kidneys naturally. For hundreds of years now, it has acted as a diuretic that fights off gallbladder stones, kidney stones, urinary tract infections and bladder infections.
Take 2,500 mg of parsley extract powder per day, or as recommended by your physician. Parsley is best to take with food.
Red Clover
Red clover tea contains mild diuretic qualities, which means it boosts urination to help get rid of excess salts, fats, water and toxins from the body, thus relieving the workload and strain in the kidneys and liver.
Take 1,500 mg of red clover extract powder daily with water or food, or according to your physician’s directions.
Ginger
The phenolic substances in ginger are believed to help ease gastrointestinal irritation, encourage bile and saliva production, and stifle gastric contractions as fluids and food move through the gastrointestinal tract.
Take 1,000 mg of ginger root extract powder once a day, or as suggested by your physician.
Goldenrod
Goldenrod is a natural diuretic. It encourages both reduced water retention and urination in the body. This helps to get rid of renal deposits, which could otherwise progress to become kidney stones.
Goldenrod also promotes overall kidney and urinary tract health by removing dangerous organisms which could cause harm.
Talk to your doctor about the right goldenrod serving size for you.
Vitamin D
Research has shown that many people with kidney disease have low levels of vitamin D. Vitamin D is essential in sources for bright for intestinal absorption of calcium and phosphorus. Kidney disease may cause altered vitamin D metabolism, leading to low levels of vitamin D. Low vitamin D levels have been linked to increased risk of heart disease, high blood pressure and worsened kidney function. Supplementing with vitamin D under medical supervision may improve vitamin D status and kidney function.
The Bottom Line
Rhabdomyolysis is the disintegration of skeletal muscle, followed by the release of skeletal muscle components into the bloodstream. Substances released include myoglobin, creatine kinase (CK), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and electrolytes like potassium.
A typical sign of rhabdomyolysis is this trio of symptoms — muscle weakness, muscle pain (particularly in the thighs, lower back or shoulders), brown or dark red urine (resembling tea), or reduced urine output.
But some individuals with rhabdomyolysis might not have muscle-related symptoms. Patients can also experience nausea and vomiting, abdominal pain, fever, confusion, rapid heartbeat, loss of consciousness or dehydration.
These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease