What Causes Rhabdomyolysis?

Rhabdomyolysis is a rare medical emergency that involves a breakdown of muscle tissue causing highly concentrated myoglobin to be released into the blood. Myoglobin is a protein normally found inside muscle cells and plays a critical role in muscle function. When it is released into the blood, myoglobin has a toxic effect on the body and can cause serious damage to the kidneys. Medical intervention is crucial to ensure kidney failure does not occur. Early treatment can completely prevent kidney damage. Getting treatment too late can result in permanent damage or death.

Rhabdomyolysis is usually caused by a specific event, such as an injury, and the onset of symptoms is rapid.

Severe Burns

Severe burns can sometimes cause rhabdomyolysis. Third-degree burns cause serious damage to small blood vessels called capillaries, which then start to leak, causing swelling and dangerously increased pressure in the muscle. This is known as compartment syndrome. The high pressure can lead to muscle breakdown. Patients with severe burns are more likely to develop rhabdomyolysis if they are immobile for a long time; this can occur if they pass out or if they undergo surgery. This is because keeping the burned body part immobile allows more pressure to build in the area. Electrical burns are more likely to cause rhabdomyolysis than other types of burns. Individuals sometimes develop rhabdomyolysis after being struck by lightning because of the resulting burns.

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Muscle Contractions From Prolonged Seizures

Muscle contractions from prolonged seizures are one of the most common causes of rhabdomyolysis. Seizures are usually associated with epilepsy, but they can also be caused by excessive alcohol consumption or extremely high fevers. A seizure can involve muscle spasms or convulsions, which may cause damage to the muscles. The amount of muscle damage depends on the duration and severity of the seizure.

Grand mal seizures are the most likely to cause muscle damage, but they usually only last a few minutes. A longer-lasting seizure is a medical emergency whether it causes rhabdomyolysis or not. In addition to muscle damage from convulsions, seizures can also cause falling accidents that result in muscle injury. Furthermore, seizures often cause unconsciousness. The resulting lack of body movement augments the risk of pressure building up in the injured muscles.

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Crush Injuries

Crush injuries can cause rhabdomyolysis because they cause direct damage to the muscle tissue. This type of injury can occur during a car crash or when a heavy object falls on someone. Large numbers of crush injuries and resulting rhabdomyolysis cases can be expected after mass casualty events such as earthquakes. When a muscle is crushed, it becomes compressed. Pressure then builds up to a dangerous level in the injured area, causing compartment syndrome. Muscle tissue is broken down, releasing myoglobin. During this time, it is also common for a severe electrolyte imbalance to develop. For example, potassium levels can become dangerously concentrated. When the source of compression is removed from the injured body part, the concentrated myoglobin flows from the damaged muscle tissue and begins to circulate the body. The kidneys cannot handle the concentrated levels of myoglobin, especially when an electrolyte imbalance is added to the equation.

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Extreme Physical Activity

On rare occasions, extreme physical activity can cause rhabdomyolysis. This can happen if someone does an incredibly strenuous workout beyond their fitness level. An example is running a marathon without adequate preparation. Drinking a lot of water before, during, and after strenuous exercise can prevent rhabdomyolysis by diluting the concentration of myoglobin in the blood. The dilution allows the kidneys to process the myoglobin more easily. Taking in electrolytes is also important after a taxing workout. A simple sports drink can re-balance the electrolytes and prevent dehydration. Consuming alcohol after strenuous exercise can make rhabdomyolysis more likely to occur because it causes dehydration and prevents the muscles from recovering properly.

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Genetic Muscle Diseases

There are several rare genetic muscle diseases that can cause rhabdomyolysis. Some examples are McArdle's disease and Duchenne muscular dystrophy. In McArdle's disease, also known as GSD V, the sufferer lacks an enzyme needed to break down glycogen. Glycogen is a form of glucose stored in the muscles. Individuals with this condition have to be careful not to exercise too vigorously. Duchenne muscular dystrophy is characterized by a lack of dystrophin, which is a protein that holds muscle cells together.

In addition to these diseases, a genetic deficiency of carnitine or lactate dehydrogenase can lead to rhabdomyolysis. These compounds are involved in energy production in the muscle cells; carnitine also plays a role in removing toxins from muscle cells. A deficiency in carnitine or lactate dehydrogenase can cause issues with breaking down sugars in the muscles.

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Heat Stroke Or Hyperthermia

It's possible for heat stroke or hyperthermia to lead to rhabdomyolysis. Hyperthermia is the medical term for dangerously high body temperature. It's common for athletes to experience heat exhaustion when they run in warm conditions, and average individuals may experience it if they spend too much time outside on very hot days. However, heat stroke is a much more serious condition. With heat exhaustion, the body's core temperature isn't significantly elevated. But with exertional heat stroke, the core body temperature is elevated to more than 104 degrees Fahrenheit, and the individual exhibits symptoms of organ damage due to this elevated temperature. In cases that present with rhabdomyolysis, the core body temperature causes muscle fibers to die and release toxins into the blood. This can then lead to kidney failure. Other heat stroke symptoms might include altered mental states, upset and agitation, and ataxia. In serious cases, individuals have experienced seizures or go into a coma. Athletes have a higher risk of exertional heat stroke, but the condition can affect anyone.

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Diabetic Ketoacidosis

Diabetic ketoacidosis is a life-threatening condition that can occur in diabetes patients. It occurs when the body begins breaking down fat deposits at extremely accelerated rates. The liver turns the fat into ketones, a chemical that turns the blood acidic. Diabetic ketoacidosis occurs when an individual's insulin is so low that sugar can't be used as food for cells. This leads to the liver producing massive amounts of blood sugar. Since the body isn't taking in energy from food, it breaks down fat storages for energy at too-rapid rates. By itself, diabetic ketoacidosis can be life-threatening. But coupled with rhabdomyolysis, it can truly devastate an individual's body. Rhabdomyolysis occurs in diabetic ketoacidosis patients when the body breaks down muscle fibers in addition to fat storages. Alternatively, muscle fibers may die because they aren't getting an energy supply. They release chemicals into the bloodstream, which, in diabetic ketoacidosis patients, has already become acidic. Other serious metabolic disorders can cause rhabdomyolysis when they cause muscle cells to break down or die.

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Bacterial Infections

Bacterial infections can cause a huge range of symptoms depending on the type of infection, the part of the body infected, and how long the infection has gone on. When a bacterial infection causes toxins to accumulate in the bloodstream or an individual's tissues, it can cause rhabdomyolysis. There have been cases reported where a localized bacterial infection in a muscle led to the condition when the muscle fibers broke down and released toxins. The most commonly associated bacteria are Legionella, which have caused most reported bacteria-caused rhabdomyolysis cases. It's also important to note other infections can cause the condition as well, such as some viral infections. The most common ones are influenza A and B. There have also been cases of the condition developing due to HIV, Epstein-Barr virus, herpes simplex virus, West Nile virus, varicella-zoster virus, and other viruses.

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Electric Shock Injury

Rhabdomyolysis can be caused by traumatic injuries to a muscle or group of muscles. Injuries from electric shocks seem to be susceptible to the condition. Third-degree burns, as mentioned, and lightning strike injuries are equally susceptible. With an electric shock, the body touches an electrical source of energy, causing energy to flow through part of the body. Injuries from electricity can vary widely depending on the voltage and how much of the body was affected. Low voltage currents with less than five hundred volts don't usually cause serious injury, but currents higher than five hundred volts may cause serious damage to the body's tissues. A low voltage shock that causes no symptoms doesn't usually need medical treatment, but it should be monitored. However, high voltage shocks require emergency medical intervention. Patients may develop rhabdomyolysis because the injury causes the death of muscle tissue, followed by the release of toxins in the blood.

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Venom From Bites

The venom from an insect or snake bite can cause rhabdomyolysis to develop. There have been many documented cases where snakebites caused localized necrosis of the soft tissues around the bite. It's less common for victims to have more extensive muscle damage, but it's not unheard of. When venom leads to muscular damage and necrosis, the dead fibers release toxic chemicals into the blood. The skeletal muscles in mammals appear to respond to myotoxic venom with damage and possibly cell death. Researchers have done studies to try to ascertain exactly how the muscle damage occurs and what parts of the muscle are damaged. The subcellular parts of the muscle fibers seem to be more sensitive to venom, while other parts of the tissue's structure might be untouched entirely.