Rhabdomyolysis

Rhabdomyolysis (often called rhabdo) is a serious condition that happens when damaged muscle tissue breaks down rapidly. As muscle cells break apart, they release proteins and electrolytes into the bloodstream. In severe cases, this can lead to kidney damage, heart rhythm problems and life-threatening complications. 

While rhabdomyolysis is uncommon, it can happen after intense exercise, injury, infections or certain medications. Early treatment is critical to prevent permanent damage.

At Banner Health, we provide the care and support you need to manage rhabdomyolysis.

What is rhabdomyolysis and how does it affect the body?

Rhabdomyolysis, or rhabdo, is a serious medical condition caused by damaged muscle cells. This damage releases proteins like myoglobin and electrolytes such as potassium, calcium and enzymes such as creatine kinase (CK) into the blood.

• Myoglobin is a protein that carries oxygen to your muscles. When it is released into the bloodstream in high amounts, it can clog the kidneys and lead to serious problems. 
• High potassium levels can affect heart rhythms and lead to dangerous cardiac issues. 
• Calcium imbalances can cause muscle weakness or life-threatening conditions.
• Creatine kinase (CK) is an enzyme released when muscles are damaged. High CK levels in the blood are a key sign of rhabdomyolysis. High CK levels can cause muscle weakness, pain and dark-colored urine.

Rhabdo can range from mild to severe, but quick medical care can prevent complications.

What are the symptoms of rhabdomyolysis?

The symptoms of rhabdo vary depending on how severe the condition is. Symptoms can appear quickly, sometimes within hours of muscle damage. Common signs include:

• Muscle pain, weakness or swelling
• Dark urine (pee), which may look like cola or tea
• Feeling very weak or tired
• Nausea or vomiting
• Decreased urine output
• Confusion
• Fever (if infection-related)

Some people may not notice signs right away. Symptoms may develop one to three days after the injury. Other symptoms, such as a fast heart rate, trouble breathing, swelling in the hands or feet or unexplained bleeding, may occur as the condition worsens.

Seek emergency care immediately if you have severe muscle pain, dark urine, decreased urination, chest pain or confusion.

What causes rhabdomyolysis?

Rhabdomyolysis happens when muscle tissue is severely damaged and breaks down quickly. This damage can occur for several reasons: 

• Intense physical activity: Extreme exercise, especially if you are not used to it, can strain muscles. High-intensity interval training, long-distance running, military training or heavy weightlifting may increase the risk, particularly in hot weather. 
• Traumatic injuries: Car accidents, crush injuries, severe falls or being trapped under heavy objects can cause significant muscle damage. 
• Prolonged immobility: Being unconscious, heavily sedated or unable to move for long periods can put pressure on muscles and lead to breakdown. 
• Heat-related illness: Heat exhaustion or heatstroke can damage muscle cells, especially when combined with dehydration. 
• Medications and substances: Certain prescription medications, including some cholesterol-lowering drugs (such as statins), may increase the risk in rare cases. Illegal drugs such as cocaine or heroin and heavy alcohol use can also trigger muscle breakdown. 
• Infections or medical conditions: Severe bacterial or viral infections, seizures, metabolic disorders and inherited muscle diseases may contribute to rhabdomyolysis. 

In many cases, more than one factor is involved. For example, intense exercise combined with dehydration or heat exposure can increase the likelihood of developing rhabdo. 

Who is at risk for rhabdomyolysis?

Some people are more likely to develop rhabdo due to certain risk factors:

• Endurance athletes: Athletes who push their bodies to the limit are at higher risk.
• Dehydration: Not drinking enough water makes it harder for the body to handle muscle stress.
• Pre-existing health condition: People with conditions like diabetes, kidney disease or neuromuscular disorders are more likely to develop rhabdomyolysis.
• Low potassium levels: People who exercise vigorously and have low potassium levels are at higher risk. 
• Substance use disorder: People who use illegal substances like heroin or cocaine or abuse alcohol are at greater risk.
• Older adults: As people age, their muscles can be more vulnerable to damage.

How do doctors diagnose rhabdomyolysis?

A health care provider will diagnose rhabdo through a physical exam, lab tests and sometimes imaging.

Here’s what to expect:

• Medical history and exam: Your provider will ask about recent activities, injuries or medications.
• Blood tests: To check for high levels of creatine kinase (CK), a key marker of muscle damage. Rhabdomyolysis is often diagnosed when CK levels are significantly elevated - typically five times higher than normal. The higher the CK level, the greater the risk of kidney complications.
• Urine tests: Dark-colored urine and proteins in urine help confirm the diagnosis.
• Imaging: Sometimes, your provider may use imaging tests to check for muscle damage.

How is rhabdomyolysis treated?

Treatment for rhabdo depends on the severity of the condition. The main goals are to protect the kidneys and prevent further injury from this muscle disease. Treatment focuses on aggressive IV fluids to protect kidney function, correcting electrolyte imbalances and closely monitoring urine output. Severe cases may require intensive care.

For mild cases, you may be able to treat it at home with rest, hydration and monitoring. 

However, most people with rhabdo - especially those with high CK levels, kidney problems and muscle damage - will need hospital treatment. Treatment may include:

• Intravenous (IV) fluids: You will likely get fluids through an IV. This helps flush out the harmful substances in your body and keeps your kidneys working.
• Monitoring: Health care specialists will check your kidney function and perform blood and urine tests to ensure everything works well.
• Rest: Resting is important. Your muscles need time to heal.
• Medications: Sometimes, you may receive medications to help with pain or prevent complications.
• Dialysis: If the rhabdo is severe and causes kidney failure, you may need more advanced treatments, like dialysis. Dialysis helps your kidneys filter out waste, extra fluids and toxins from your blood. 

The earlier you get treated, the better the chances of recovery. Always seek emergency medical care if you think you have rhabdo.

What complications can rhabdomyolysis cause?

If rhabdo is not treated quickly, it may lead to serious complications. These complications can cause kidney damage and affect other parts of the body.  

Here are some of the main risks:

• Kidney failure: The breakdown of muscle tissue can harm the kidneys (acute kidney injury), leading to kidney failure.
• Compartment syndrome: This happens when swelling in muscles increases pressure and cuts off blood flow. It can cause severe pain and damage.
• Electrolyte imbalance: Changes in electrolytes like potassium, sodium and calcium can lead to heart arrhythmia (irregular heartbeat) or cardiac arrest (heart stops).
• Permanent muscle damage: Severe rhabdo can cause lasting damage to muscles, leading to weakness or loss of movement.
• Shock or death: In the most serious cases, rhabdo can be fatal if not treated in time.

How can you prevent rhabdomyolysis?

While not all cases can be avoided, you can lower your risk by taking these steps:

• Stay hydrated: Stay well hydrated before, during and after intense physical activity, especially in hot conditions.
• Pace yourself: Slowly increase the intensity of your workouts. Avoid pushing your body too hard too quickly.
• Protect yourself: Wear appropriate gear to prevent injuries during physical activity.
• Be mindful of medications: Talk to your health care provider about side effects that could harm your muscles.
• Know your limits: Rest if you feel unwell. Listen to your body.

Simple changes to your routine can make a big difference in keeping your muscles healthy. 

Why choose Banner Health for rhabdomyolysis care?

Banner Health emergency departments and hospitals are equipped to diagnose and treat rhabdomyolysis quickly. Our teams use advanced laboratory testing and kidney monitoring to prevent complications and support recovery.