Rhabdomyolysis is the rapid destruction of skeletal muscle resulting in leakage into the urine of the muscle protein myoglobin.

There are three different types of muscle in the human body;
a. Smooth muscle
b. skeletal muscle and
c. heart muscle

The skeletal muscle is the muscle of movement of the body (moving the skeleton at the joints). Skeletal muscle is affected by rhabdomyolysis.

Myoglobin is a protein component of the muscle cells that is released into the blood when the skeletal muscle is destroyed in rhabdomyolysis.

Creatine kinase is an enzyme (a protein that facilitates chemical reactions in the body) also in the muscle cells.
The level of each of these protein can be measured in blood to monitor the degree of muscle injury from rhabdomyolysis.
Myoglobin can also be measured in samples of urine.

Causes:
Rhabdomyolysis has many causes.

Some of the common ones include:
– muscle trauma or crush injury
– severe burns
– physical torture or child abuse
– prolonged lying down on the ground (people who fall or are unconscious and are unable to get up for several hours),
– prolonged coma
– severe muscle contractions from prolonged seizures
– cocaine use with related hyperthermia (increased body temperature),
– extreme physical activity (running a marathon)
– drug and alcohol intoxication
– low circulating phosphate, potassium, or magnesium levels in the blood (electrolytes)
– genetic muscle diseases (familial paroxysmal rhabdomyolysis),
– prolonged drowning or hypothermia (low core body temperature),
– medications: medications such as Parkinson’s medication, psychiatric medications, anesthesia medications, HIV medications, colchicine
– variety of viruses and some bacteria
– severe hypothyroidism (low thyroid level)
– lack of blood perfusion to a limb
– some inflammatory disorders of the muscle, called myopathies, (myositis, dermatomyositis, polymyositis),
– venom from certain snake bites

Symptoms:
Rhabdomyolysis may not cause any symptoms at all.
Muscle aches and pain (myalgia)
stiffness and
muscle weakness
Rhabdomyolysis may cause a darkening of the urine color
Myoglobin is released from the muscles when they break down and is excreted into the urine. This can cause a red color of the urine.

Diagnosis:
Rhabdomyolysis is suggested by the history of recent and past events and the physical examination.

It is confirmed by blood and urine testing.

An important part of diagnosing rhabdomyolysis is a comprehensive medical history and physical examination.

The medical history may include questions about any medication use, drug and alcohol use, other medical conditions, any trauma or accident, etc.

Blood tests include a complete blood count (CBC), serum electrolytes, muscle enzymes, and urinalysis.

The diagnosis of rhabdomyolysis is confirmed by detecting elevated muscle enzymes in blood.

Muscle enzymes include creatine phosphokinase (CPK), SGOT, SGPT, and LDH. The levels of these enzymes rise as the muscle is destroyed in rhabdomyolysis.

CPK is also in heart muscle (cardiac muscle) and brain.

The laboratory is usually able to distinguish between the different components of this enzyme.

The levels of myoglobin can be elevated in blood and urine.

Complications:
The complications of rhabdomyolysis can occur early or late in the disease. Early complications occur within the first 12 hours and include:
Hyperkalemia
Hypocalcemia
Hepatic inflammation
Cardiac dysrhythmia
Cardiac arrest

Late complications usually develop after the initial 12 to 24 hours and include disseminated intravascular coagulation (DIC) and acute renal failure.

DIC usually worsens between the 3rd and 5th day after initial presentation, and it usually resolves spontaneously if the rhabdomyolysis is treated appropriately.

Acute renal failure develops in up to two thirds of patients.Renal failure
Treatment:
The treatment of rhabdomyolysis depends on its cause and severity.

If a cause for rhabdomyolysis is identified, it is addressed; for example:
– discontinuing a toxic medication,
– replacing electrolytes, or
– treating an underlying muscle disease.

In cases of mild rhabdomyolysis without any evidence of complications, management can take place at home by simply recognizing the cause and correcting it, such as discontinuing a medication and rehydration.

In more severe cases, or if home therapy is not possible, hospitalization may be required.

Prompt initiation of hydration with intravenous fluids, in addition to the removal the provoking factor(s), is an essential part of the treatment of rhabdomyolysis.

Monitoring and managing kidney dysfunction, correcting any disturbance in the electrolytes, and monitoring the muscle enzyme levels (CPK, SGOT, SGPT, LDH) are most effectively done in the hospital when rhabdomyolysis is severe.

Prognosis:
The overall prognosis of rhabdomyolysis is favorable as long as it is recognized and treated promptly.
Most causes of rhabdomyolysis are reversible.

Severe cases of rhabdomyolysis may be associated with kidney damage and electrolyte imbalance and hospitalization and even dialysis can be required.

Author Bio: steven is associated with dermatology billing services and cardiology billing services and medical coding training

Category: Medicines and Remedies
Keywords: dermatology, billing, services