Rhabdomyolysis, or "rhabdo," is the breakdown of muscle fibers that releases substances from inside the muscle cells into the bloodstream. This condition can cause symptoms such as muscle weakness, fatigue, and dark-colored urine.

It can develop after intense or prolonged physical exercise, serious injuries, alcohol or drug intoxication, or extended periods of immobilization.

Treatment for rhabdomyolysis is provided by a doctor and varies depending on the cause. It usually requires hospitalization and intravenous (IV) fluids to prevent complications such as acute kidney failure.

female healthcare provider assessing patient's leg

Rhabdomyolysis symptoms

The main symptoms of rhabdomyolysis include:

Muscle pain or stiffness;
Muscle weakness or loss of strength;
Difficulty moving the arms or legs;
Joint pain, abdominal pain, or pain in the kidneys;
Dark, cola-colored urine in small amounts;
Muscle cramps;
Nausea or vomiting.

Other possible symptoms may include general malaise, fever, confusion, agitation, delirium, or heart palpitations.

It’s important to go to the emergency room as soon as symptoms appear so the diagnosis can be confirmed and treatment started quickly to prevent complications.

Confirming a diagnosis

The diagnosis of rhabdomyolysis is made in the hospital by a doctor through an evaluation of symptoms, medical history, and lab tests.

Blood and urine tests are ordered to measure levels of electrolytes, myoglobin, and creatine phosphokinase (CPK test).

Additional tests such as an electrocardiogram, chest X-ray, or liver function tests may also be requested.

Possible causes

Rhabdomyolysis occurs when muscle fibers are destroyed due to injury or muscle tissue necrosis.

This process leads to the release of calcium, sodium, potassium, myoglobin, creatine phosphokinase, and the enzyme alanine transaminase (ALT) from the muscle into the bloodstream.

Risk factors

The main factors that increase the risk of developing rhabdomyolysis include:

Intense or prolonged physical activity;
Severe trauma or accidents, such as falls from heights or car crashes;
Intoxication with alcohol, opioids, or mushrooms;
Muscle diseases such as myopathy, pyomyositis, or polymyositis;
Neuroleptic malignant syndrome, malignant hyperthermia, hypothermia, or frostbite;
Infections, especially in children.

Prolonged immobilization due to coma, hip fracture, or surgeries that require long recovery periods can also lead to rhabdomyolysis.

Other causes include the use of antipsychotics, corticosteroids, diuretics, or statins, as well as recreational drug use such as cocaine, heroin, or amphetamines.

Rhabdomyolysis can also occur as a result of Haff disease, insect or snake bites, electrical shock, metabolic disorders, or stroke.

Rhabdomyolysis treatments

Treatment for rhabdomyolysis should be carried out in the hospital under medical supervision. The main goal is to prevent complications, and the approach may vary depending on the cause.

1. Intravenous fluids

IV fluids are given to prevent dehydration and acute kidney injury caused by the accumulation of muscle breakdown products in the blood.

Electrolyte replacement may also be administered intravenously based on the results of lab tests.

2. Monitoring kidney function

Kidney function is closely monitored during hospitalization by measuring daily urine output and performing kidney tests to ensure that renal function remains normal.

In some cases, urine alkalinization with intravenous sodium bicarbonate may be recommended to prevent uric acid buildup, correct metabolic acidosis, and reduce the risk of hyperkalemia.

3. Use of medications

Medications may be prescribed to treat complications associated with rhabdomyolysis.

Allopurinol can be used if uric acid levels are elevated. Antibiotics may be prescribed for infections, and corticosteroids are used for inflammatory muscle conditions.

4. Discontinuing medications

If rhabdomyolysis is caused by a specific medication, the doctor will recommend stopping the drug and switching to an alternative treatment.

5. Hemodialysis

In severe cases where the kidneys produce very little urine, the doctor may recommend hemodialysis.

This treatment supports kidney function and helps remove excess substances from the bloodstream.

6. Diet for rhabdomyolysis

Dietary changes may be recommended when rhabdomyolysis is linked to hereditary muscle diseases (myopathies). These changes should be guided by a doctor and a registered dietitian.

People with phosphorylase deficiency are generally advised to increase their intake of glucose and fructose.

Those with carnitine-palmitoyltransferase deficiency are usually recommended to follow a high-carbohydrate, low-fat diet.

7. Surgery

Surgery for rhabdomyolysis, known as fasciotomy, may be required when complications such as compartment syndrome occur.

This procedure involves cutting the fascia surrounding the affected muscle to relieve pressure and prevent tissue necrosis.

8. Blood transfusion

If disseminated intravascular coagulation (DIC) develops, a blood transfusion may be necessary.

This treatment uses frozen plasma to prevent bleeding or hemorrhage.

Possible complications

The main complications of rhabdomyolysis include:

Acute kidney injury or renal failure;
Cardiac arrhythmias;
Disseminated intravascular coagulation (DIC);
Hospital-acquired infections;
Compartment syndrome.

It is essential to seek medical care immediately when symptoms appear to ensure prompt treatment and avoid life-threatening complications.

Prevention measures

The best way to prevent rhabdomyolysis is to stay hydrated by drinking plenty of water before and after strenuous or prolonged exercise.

It is also important to maintain good hydration following muscle injuries, when working in hot environments, or if you have a degenerative muscle condition.

Drinking enough water helps dilute the urine and support kidney function, allowing the elimination of myoglobin released from the muscles and reducing the risk of rhabdomyolysis.

Rhabdomyolysis: Symptoms, Risk Factors, Treatment & Prevention