Rhabdomyolysis is a general term indicating destruction of muscle tissue. There are multiple causes for this rhabdomyolysis, the consequences of which are more or less serious depending on the origin of the disorder.

The term rhabdomyolysis is composed of the suffix -lyse meaning destruction, is the term rhabdomyo- designating the skeletal striated muscle, that is to say all the muscles of the human body with the exception of the heart muscle (myocardium) and smooth muscles (used for involuntary motor skills such as intestinal motor skills or that of blood vessels).

When muscle cells are destroyed, many molecules are released into the blood. One of these is an enzyme that only exists in muscle cells. It is creatine phosphokinase, referred to more simply as CPK. This molecule is assayed in current practice. The higher the dosage, the greater the rhabdomyolysis.

The causes of rhabdomyolysis are very varied. We will resume here a non-exhaustive list of the most common causes of rhabdomyolysis:

Trauma / compression

Compression of a limb, for example crush syndrome, in which a person gets stuck under a car or under the rubble of an earthquake, causes rhabdomyolysis which is often severe.

Prolonged immobilization causes muscle compression which can lead to rhabdomyolysis (loss of consciousness, long-term surgery, etc.).

Excessive muscle contraction

• Epileptic crisis
• Excessive sports activity (marathon, ultra-trail)

Infections

• Virals: influenza
• Bacterial: legionellosis, tularemia
• Parasitic: malaria, trichinellosis

Severe fever

• Neuroleptic malignant syndrome
• Heatstroke
• Malignant hyperthermia

Toxic

• Alcohol
• Cocaine
• Heroin
• Amphetamines

Medicinal

• Neuroleptics
• Statins

Autoimmune

• Polymyosite
• Dermatomyosite

Genetics

In some cases, the context is obvious, for example during a limb crush or a prolonged coma.

In other cases, the signs of muscle destruction may be more difficult to see. Muscle pain can consist of stiffness-type pain or muscle pain on palpation. There may be muscle edema which can lead to compartment syndrome. Sometimes the only muscle sign is a feeling of muscle weakness.

Sometimes the sign for a doctor is a change in the color of the urine. In fact, the myoglobin released by muscle cells colors urine red turning brown (ranging from Ice-Tea to Coca-Cola).

The diagnosis of rhabdomyolysis is established by a CPK assay. We talk about rhabdomyolysis if the CPKs are five times higher than normal.

The main complication of rhabdomyolysis is acute renal failure. This is multifactorial but we note the toxicity of myoglobin and its accumulation in the renal tubules leading to an obstruction to the flow of urine. Renal failure can be accompanied by other metabolic disorders including hyperkalaemia. Hyperkalaemia is the increase of potassium in the blood. This complication can lead to death if potassium is not returned to normal levels in the blood as soon as possible. This often requires the use of dialysis.

The other consequence, which we have already mentioned is compartment syndrome. It is a tensioning of the muscular compartments. This is manifested by very severe pain and painful edema of the muscles. Surgical decompression called a “discharge aponeurotomy” should be performed as soon as possible, once compartment syndrome is confirmed.

As we have seen previously, the causes of rhabdomyolysis are very varied. The treatment obviously depends on the cause.

In general, the treatment of rhabdomyolysis aims to avoid complications.

In order to avoid acute renal failure, adequate rehydration should be ensured as dehydration is a risk situation for renal complications. In an acute situation it is necessary to check regularly that the potassium in the blood is within the normal limits. Finally, monitoring of muscle pain makes it possible to suggest compartment syndrome.

In conclusion, we can specify that there is rhabdomyolysis and rhabdomyolysis. Acute rhabdomyolysis by compression of a limb, for example, can lead to death. In contrast, rhabdomyolysis during the flu is just an “epiphenomenon” that no one will worry about. Diseases related to rhabdomyolysis remain rather rare, excessive physical exercise being the most common. Always think about it and bring up rhabdomyolysis in front of unusual muscle pain or abnormal red-brown coloring of the urine.