Rhabdomyolysis T79.6

Mostly acute necrosis of the striated skeletal muscles with release of intracellular muscle components (especially myoglobulin), which are excreted renally and can precipitate in the acidic environment of the renal tubules. The consequences are electrolyte and renal dysfunction and possibly acute renal failure.

Myoglobulin gets into the circulation when there is severe damage to the sklet muscle. Skeletal muscle damage is polyätiological:

• traumatic: injuries, operations, burns, necroses after injections, physical exertion such as marathon runs, seizures),
• toxic/medicinal: drugs such as statins and fibrates. Statins can induce rhabdomyolysis, especially when their degradation via the cytochrome P450 isoenzymes is inhibited by other drugs or by food (inhibitors of this enzyme are for example azole antifungals, macrolides, HIV protease inhibitors or verapamil). Other common drugs that can trigger rhabdomyolysis are: levofloxacin, cotrimoxazole, colchicine, heroin, theophylline, risperidone, ezetimib, venlafaxine and fibrates in combination with statins. Rhabdomyolysis may also occur under doxazosin, mirtazapine or gabapentin. Furthermore by poison effects (fungal poisons, snake poisons).
• infectious (viral infections, mycoplasma, gas fire)
• severe chronic muscular diseases (myositis such as polymyositis, rare dermatomyositis, muscular dystrophy)

Myalgias, myoglobulinemia, myoglobulinuria, muscle weakness

CK >10,000U/l, CK-MB content usually < 6%. Occurrence of myoglobin in urine (red coloration)

Elimination of the cause. Symptomatic: correction of electrolytes, forced diuresis, possibly renal replacement therapy.

1. Chavez LO et al (2016) Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. Crit Care 20:135.
2. Descamps V et al (2016) Skin manifestations in ultra-marathon runners: experience in the Marathon des Sables 2014 Br J Dermatol doi:10.1111/bjd.15182.
3. Frydrychowicz C et al (2017) Colchicine triggered severe rhabdomyolysis after long-term low-dose simvastatin therapy: a case report. J Med Case Rep 11:8.
4. Magrini D et al (2017) Serum creatine kinase elevations in ultramarathon runners at high altitude. Phys Sportsmed doi: 10.1080/00913847.2017.1280371.