In rhabdomyolysis, voluntary (striated) muscle breaks down. There are many causes, such as an injury to the muscle, autoimmune disease, or alcohol or drug abuse.
What is rhabdomyolysis
In rhabdomyolysis, muscle fibers in skeletal muscle break down. This means that the muscle begins to disintegrate. In the process, large amounts of myoglobin are released. These reach the kidneys via the bloodstream. This can lead to considerable damage and even acute kidney failure. Therefore, medical help is absolutely and immediately necessary. There are different types: traumatic (physical), non-traumatic (non-physical), load-dependent and load-independent rhabdomyolysis. For example, load-dependent rhabdomyolysis can result from training too hard.
Causes
A wide variety of factors can trigger this condition, including diseases such as malignant hyperthermia (life-threatening skeletal muscle dysfunction), acute toxic myopathy (muscle damage caused by toxins or drugs), autoimmune diseases, metabolic disorders, drugs, or ethanol. Ischemias (undersupply of tissue area with blood) or a lack of oxygen are also among the triggers. The most common causes are excessive muscle stretching, muscle pressurization, and crush injury. In bodybuilding circles, there is always a warning that very hard training, during which the muscles are severely overloaded, and a simultaneous lack of fluids, can lead to acute muscle inflammation and thus to rhabdomyolysis. The same is true if the training sessions are too rapid in succession. Toxic causes include cocaine and contagious triggers include infection. Poisoning from snakebites can lead to disintegration of voluntary (striated) muscle, resulting in rhabdomyolysis. Electrolyte imbalances can also lead to rhabdomyolysis.
Symptoms, complaints, and signs
Swollen, soft, and sore muscles are the most obvious sign of rhabdomyolysis, while nausea, vomiting, diarrhea, fever, lightheadedness, and severe fatigue are among the nonspecific symptoms. The condition may be accompanied by muscle pain, cramps and stiffness or swelling of the muscles with subsequent paralysis. At the latest when the urine turns reddish brown, a medical doctor must be consulted immediately, as this is a sign of a very high myoglobin content in the blood and acute renal insufficiency. Myoglobin is a protein that is responsible for transporting oxygen within the muscles. If it cannot be filtered in the kidney, the urine becomes colored. The symptoms of rhabdomyolysis should not be underestimated, as some of them are life-threatening.
Diagnosis and course of the disease
Mild rhabdomyolysis is often detected by elevated levels of enzymes normally found in muscle, such as myoglobin, creatine kinase, and lactate dehydrogenase. When myoglobin levels are high, the urine turns red-brown due to excretion of myoglobin by the kidneys. Diagnosis includes a detailed history, clinical examination, laboratory, electrophysiology, muscle biopsy with pathobiochemistry, muscle MR, and in some cases electron microscopy.
Complications
Rhabdomyolysis is a complication of various traumatic or nontraumatic processes. Injury or crushing of muscle tissue can cause dissolution of transversely striated muscle, as can certain poisons (snake venom), infections, medications, drugs, or immunologic diseases. The most dangerous complication of rhabdomyolysis can develop due to increased excretion of myoglobin by the kidneys. Myoglobin forms during the breakdown of muscle tissue. It often causes tubules in the kidneys to become obstructed, and the iron contained in the heme damages the tubule cells. As a result, tubule tissue may die, often causing acute renal failure. Furthermore, the so-called compartment syndrome may occur, which is also a severe emergency. In this case, venous blood outflow obstructions due to swelling in the muscle area prevent the inflow of arterial blood, which leads to an undersupply of the muscles and the resulting further necrosis of muscle tissue.At the same time, hyperuricemia, characterized by an increase in the level of uric acid in the blood, often occurs. The symptoms of gout can develop from this. In addition, electrolyte disorders such as hyperkalemia, hyperphosphatemia and hypokalcemia not infrequently occur. These lead to cardiac arrhythmias, heart failure, seizures, tetany, circulatory collapse, and psychological impairment such as depression or anxiety disorders. A further complication is the threatening drop in the platelet count, which simultaneously leads to thrombosis and a strong tendency to bleed.
When should you see a doctor?
Rhabdomyolysis should always be treated by a physician. There is usually no self-healing in this disease, and in most cases there is also a marked deterioration in the patient’s general condition. The earlier the disease is detected and treated, the higher the chance of success. A doctor should be consulted for rhabdomyolysis if the affected person suffers from vomiting and nausea. Fever or severe pain in the muscles may also indicate the disease and should be examined by a doctor. In severe cases, paralysis of the muscles can also occur, so that the affected person suffers from restrictions in movement and can also no longer move around without problems. If rhabdomyolysis is not treated, in the worst case it can also lead to renal insufficiency, which can be fatal. Rhabdomyolysis can be diagnosed by a general practitioner. However, it must be treated by various specialists.
Treatment and therapy
Rhabdomyolysis usually develops over a long period of time and can sometimes be reversed if the triggers are stopped in time. Although the breakdown of muscle cannot be stopped in therapeutic terms, it does regress on its own after some time. Mild rhabdomyolysis that is detected in time can be treated by a strong supply of fluids and, if necessary, additional electrolytes. Only possible damage to the kidneys and a lack of volume, as the damaged muscle binds fluid, must be counteracted in time. Damage to the kidneys can be prevented with forced diuresis. In this case, several liters of fluid (physiological saline solution) are given to the affected person by infusion to accelerate the excretion of myoglobin and to dilute the myoglobin that has accumulated in the urine. If this is not sufficient, certain substances are also used to additionally lower the ph value so that the myoglobin dissolves. In extreme cases, dialysis can be used to remove the myoglobin from the blood. The kidneys are thereby cleansed to be able to function independently again. The affected muscles must not be loaded again until all abnormalities have subsided. The most important treatment goal is basically to avoid acute kidney injury. Rhabdomyolysis ends in fatal renal failure in most cases if left untreated. This results from the accumulation of decay products.
Prevention
To prevent rhabdomyolysis, it is generally necessary to avoid subjecting the muscles to excessive stress, such as overtraining. In addition, it is essential to ensure that the body does not become dehydrated before, during, and after exercise by drinking enough fluids. Beginners in sports should start slowly and gradually increase the training. Warming up the muscles is important. Exercise should be avoided if you are ill and a doctor should be consulted if you are taking medication. Training in combination with alcohol or drugs is also strongly discouraged. Adequate sleep and a healthy and balanced diet with plenty of vitamins and minerals are also very important. Furthermore, training should not be done in extreme temperatures, whether cold or hot. The strain is too great for the entire organism in intense heat or high sub-zero temperatures. Due to the extreme conditions, the body cannot process training stimuli appropriately. This can lead to erroneous reactions in the body, such as the breakdown of striated muscles.
Aftercare
After treatment for rhabdomyolysis, patients are recommended to receive follow-up care based on the previous therapy.If the muscle decomposition was caused by an infection, for example, then follow-up examinations check whether the pathogens could be eliminated from the patient’s organism. If an accident or trauma was responsible for the damage to the muscles, the healing process of the tissue is checked first and foremost during the follow-up examinations. If the kidneys have already been affected by the disease and are no longer working properly, they must take regular medication to support kidney function and promote the production of urine. Regardless of the therapy, patients who have undergone rhabdomyolysis are given a diet plan and are expected to strengthen their muscles through regular exercise. A balanced diet should help support the body’s natural healing abilities and strengthen the immune system. Light athletic exercises are used to rebuild and strengthen the lost muscles. It is very important, especially in the early stages, that patients do not overexert themselves. Otherwise, the muscles can be damaged again. There is a risk of renewed rhabdomyolysis. For this reason, care in rehabilitation therapy or adapted physiotherapy is recommended for patients.
Here’s what you can do yourself
Once the diagnosis is established, the treating physicians will try to eliminate the triggering cause of rhabdomyolysis so that the disease does not worsen. Furthermore, they will treat the disease according to its symptoms and, above all, try to prevent acute kidney failure. Since the tissue damage that has occurred can only be repaired by the body’s own repair measures, it makes sense for patients to strengthen their immune system as much as possible. Depending on their condition, they should do a lot of outdoor exercise to do this. A healthy, stress-free lifestyle also supports the immune system. Patients should therefore not smoke, drink only a little alcohol and eat a healthy diet. A healthy diet includes plenty of vitamins and minerals from fresh fruits and vegetables, whole grains and lean meat. Red meat, fatty sausage and sugar should be avoided. Plenty of rest, adequate sleep and drinking plenty of fluids – especially water – are also very important measures to support the immune system. Because many immune cells have been found in the intestines, the administration of probiotics is also recommended. This is a preparation with living microorganisms. They are supposed to multiply in the intestine and support the immune system there. Physicians with the additional designation “naturopathy” as well as alternative practitioners can make appropriate recommendations here.
