Definition
Rhabdomyolysis refers to severe damage to the skeletal muscle, resulting in the release of numerous compounds in the bloodstream, such as myoglobin, but also creatine, calcium, potassium and uric acid.
Causes of rhabdomyolysis
Possible triggers can be classified as physical and not physical. Among the physical causes we find the muscular damage related to an intense sporting activity such as bodybuilding (stress rhabdomyolysis, partly responsible for the DOMS), traumas - reported for example with an accident in the car or with an electric shock - and finally the cardiovascular diseases. The latter can clog blood vessels preventing adequate blood supply to the muscles.
Among the non-physical causes of rhabdomyolysis we find various muscular disorders (myopathies) and heavy metal poisoning, poisons injected with insect bites or snake bites, toxins in food - as in a particular species of mushroom, the equestrian Tricholoma - in some vegetable plants, such as the Conium maculatum (also known as Hemlock), and in some species of fish. Among other possible non-physical causes of rhabdomyolysis we find alcohol abuse, infections affecting bacteria (salmonella, legionella) and viruses (herpes and malaria), and the use of drugs, such as heroin, methamphetamine, cocaine, ketamine and MDMA, known as ecstasy; finally, a triggering element can be represented by the use of some medical devices, such as drugs, anesthesia and electrolytes. For this reason, if the person is being treated with drugs whose effect is to lower the level of total cholesterol in the blood - in particular if they contain statins and / or fibrates - he must pay close attention to the onset of fatigue, muscle pain and change in urine color, all symptoms that can be clear signs of rhabdomyolysis.
Symptoms
Rhabdomyolysis is characterized by very specific symptoms; among these we mention a general fatigue and a reddish-brown coloration of the urine, due to the discharge of the myoglobin pigment in the blood. To be more precise, to diagnose rhabdomyolysis, proceed with a blood and urine test. These two analyzes focus mainly on the determination of four parameters. The first is represented by the enzyme creatine kinase; based on the concentration of this enzyme in the blood it is possible to determine the extent of muscle damage (normal values 0-150 U / liter, slightly variable from laboratory to laboratory and lower in women). Naturally, the higher the creatine kinase concentration, the more severe the muscle damage will be.
The second parameter that is identified, through urine analysis, is the presence of myoglobin (myoglobinuria). As previously mentioned, myoglobin is nephrotoxic because, if present in the blood, it tends to accumulate in the kidneys, causing serious problems to these organs. When the level of myoglobin exceeds the gram / liter, the urine takes on a very dark color.
The third parameter observed is the presence of altered levels of potassium, calcium, uric acid and azotemia. Remember that the level of calcium can vary with the course of the disease; in particular, in the initial stage of rhabdomyolysis the value tends to be low (hypocalcemia). Later, as muscle necrosis progresses, hypercalcaemia can be appreciated, given the high release of calcium from damaged muscle cells.
Finally, the fourth observable parameter is the level of creatinine (normal value 50-100 micromoles / liter), which is always released by damaged muscle cells.
Treatment and prevention of rhabdomyolysis
See also: drugs for the treatment of rhabdomyolysis
The possible medical treatments for rhabdomyolysis can be multiple. Among these, the most successful is hydration with liquids through intravenous administration. This procedure, in fact, prevents the possible damage due to myoglobin poured into the blood. Another very valid therapeutic solution, useful only for the most serious cases, is hemodialysis, whose purpose is to filter the blood and retain potentially harmful substances. To treat the complications of rhabdomyolysis, it may also be necessary to take diuretic medicines (eg furosemide), which are useful for increasing urine production and avoiding possible kidney complications.
To prevent rhabdomyolysis it is necessary to drink plenty of fluids before, during and after intense exercise, in order to dilute the urine and facilitate the elimination of myoglobin from the kidneys. A very important advice to prevent this disease is to warn your doctor when the first symptoms of rhabdomyolysis appear, especially if you are predisposed to develop it (presence of myopathies or statin intake).
Healing times
Depending on the severity of rhabdomyolysis, healing times may vary. If the disease is diagnosed quickly, so when the first symptoms appear, the recovery time is just as short, and is between the week and the month. In the most serious cases, therefore in the presence of renal damage, recovery times from rhabdomyolysis are markedly longer and characterized by persistent symptoms such as muscle fatigue and general weakness.
