What is rhabdomyolysis?

Rhabdomyolysis is a serious condition caused by muscle injury. It can be caused by an accident or by overusing the muscles when resistance training.

When muscle tissue gets seriously injured, it breaks down and dies, releasing its contents — including a protein called myoglobin — into the bloodstream. It can lead to kidney complications, such as kidney failure, and changes in balance of electrolytes in the blood, which can lead to serious problems with the heart and other organs.

Rhabdomyolysis is serious and can be life-threatening. Seek medical attention urgently if you have been doing a high level of resistance training and you develop muscle swelling or weakness, and your urine is the colour of tea.

What are the symptoms of rhabdomyolysis?

Common rhabdomyolysis symptoms include:

• severe muscle aching or swelling, especially in the shoulders, thighs or lower back
• muscle weakness or stiffness, or trouble moving arms or legs
• dark red or brown urine, or reduced or no urine output
• confusion, dehydration or fever
• lack of consciousness
• pain in the abdomen (tummy) or joints

What causes rhabdomyolysis?

Rhabdomyolysis is caused by an injury to muscle tissue or following extreme exercise, such as running a marathon or doing high-intensity resistance training. Causes of rhabdomyolysis include:

• trauma or crush injuries, for example, from a car accident
• taking illegal drugs such as cocaine, amphetamines or heroin
• extreme muscle exertion, for example, running marathons or improper resistance training
• a side effect of some medicines, such as cholesterol-lowering drugs (statins) or amphetamines used for ADHD, although the risk is very low
• prolonged muscle pressure, for example when someone is lying unconscious on a hard surface
• very high body temperature (hyperthermia) or heat stroke
• dehydration
• high fever
• an infection
• being bitten or stung by wasps, hornets or snakes
• having a seizure
• drinking too much alcohol
• being born with some genetic conditions or muscular dystrophies

You are at greater risk of rhabdomyolysis if you are an older adult, have diabetes, take part in extreme sports or use a lot of drugs or alcohol.

How is rhabdomyolysis diagnosed?

Rhabdomyolysis is often diagnosed in hospital. Physical examination, blood tests and urine tests are all needed. Other tests may be needed too.

How is rhabdomyolysis treated?

Rhabdomyolysis is usually treated in hospital, with intravenous fluids to help the body produce enough urine and prevent kidney failure. Medication may be given to correct the electrolyte imbalance in the blood.

Rarely, dialysis is needed if kidney function is poor. If you have compartment syndrome, you may need immediate surgery to avoid further muscle death or nerve damage.

Early diagnosis and treatment of rhabdomyolysis and its causes increases your chances of a full recovery.

Rhabodomyolysis complications

If not treated early, rhabdomyolysis can lead to complications, such as:

• very high potassium levels in the blood (hyperkalaemia); this can lead to an irregular heartbeat or cardiac arrest
• kidney failure or problems with the liver
• an abnormal heart rhythm (arrhythmia)
• seizures
• very low blood pressure or shock
• bleeding that is hard to control
• compartment syndrome; this occurs when too much pressure builds up in the injured compartment groups of muscles (compartment). The extreme pressure hinders blood flow to and from the affected tissues and can cause further muscle damage and death.

How is rhabodomyolysis prevented?

It is important to build up to resistance training. Start slow and gradually increase the load to prevent rhabodomyolysis.