Rhabdomyolysis Causes, Symptoms, Treatment and Cost

Rhabdomyolysis is a significant medical disorder that happens when muscle fibres break down and leak their contents into the bloodstream. It can cause severe complications, including kidney damage, electrolyte imbalance, and even death.

There are three main types of rhabdomyolysis:

• Traumatic Rhabdomyolysis: This type of rhabdomyolysis is caused by physical trauma or injury to the muscles. Examples include blunt force trauma or crushing injuries.
• Exertional Rhabdomyolysis: This type of rhabdomyolysis is caused by intense or prolonged physical activity or exercise beyond the body's normal capabilities.
• Drug-Induced Rhabdomyolysis: This type of rhabdomyolysis is caused by certain medications and drugs, such as statins, cocaine, alcohol and heroin.

Rhabdomyolysis is caused by muscle injury, whether due to direct trauma or through indirect causes such as extreme exertion, electrical shock, infections, metabolic disorders and certain drugs and toxins.

In addition, genetic abnormalities can also lead to the condition.

There are rare instances in which there is no clear triggering factor, and so the reason for the rhabdomyolysis remains unknown.

• Extreme muscle weakness, pain, and tenderness.
• Dark brown urine.
• Nausea and/or vomiting
• Fever
• Rapid heart rate.
• Confusion or disorientation.

• Maintain proper hydration by consuming a lot of fluids throughout the day.
• Avoid excessive alcohol consumption and/or drug use.
• Follow a balanced and healthy diet.
• Monitor the intensity of physical activity and take breaks when needed.
• Listen to your body and take note of any signs of pain or discomfort, particularly during exercise or strenuous activity.
• Wear protective gear when engaging in contact sports or other potentially hazardous activities, such as rock climbing or mountain biking.
• Be aware of any medication side effects that may increase risk for developing rhabdomyolysis, such as statins, antipsychotics, etc.
• Maintain good overall health through regular check-ups with your doctor and practice preventive measures to reduce the chances of developing medical conditions which can lead to rhabdomyolysis (such as diabetes).

• Physical Examination: The primary method for diagnosing rhabdomyolysis is through physical examination. The doctor will look for symptoms of muscular soreness and tenderness during the physical assessment. The doctor may also look for indications of dehydration and a raised body temperature.
• Laboratory Tests: Laboratory tests are used to confirm a diagnosis of rhabdomyolysis. These tests measure levels of creatine kinase (CK), an enzyme found in muscle tissue that is released when muscle cells break down. Additionally, other tests such as urinalysis or electrolyte tests may be performed to help determine the severity of the condition and any associated complications.
• Imaging Studies: Imaging studies such as x-rays or CT scans may also be used to diagnose rhabdomyolysis if there is suspicion of an underlying cause such as trauma or pressure on a nerve in the spine or neck area. These imaging studies can help identify any fractures or other injuries that could be causing the muscle damage associated with rhabdomyolysis.

• Acute kidney injury: Rhabdomyolysis can cause severe damage to the kidneys, leading to acute kidney injury, which can lead to electrolyte imbalances and fluid overload.
• Severe muscle pain: Rhabdomyolysis can cause severe muscle pain, tenderness, and swelling due to the destruction of muscle fibers.
• Nerve damage: Damage to nerves in the affected area may occur as a result of rhabdomyolysis, causing numbness, tingling, or paralysis.
• Compartment syndrome: Compartment syndrome is a serious complication that occurs when pressure builds up within a confined space in the body, resulting in decreased blood flow and tissue death.
• Cardiac arrhythmias: Electrolyte imbalances caused by rhabdomyolysis can lead to irregular heartbeats (arrhythmias) which may be dangerous and require medical attention.

• Abhyanga: Abhyanga is a form of Ayurvedic massage that involves massaging warm oil onto the body to nourish and relax the muscles. This may aid with inflammation, circulation, and discomfort and stiffness in impacted regions.
• Herbal Remedies: Certain herbs can be used to treat rhabdomyolysis, including turmeric, ashwagandha, shatavari, ginger, licorice root, guduchi, and amalaki among others. These herbs have anti-inflammatory qualities, which may help decrease swelling and discomfort while also encouraging recovery.
• Yoga & Meditation: Practicing yoga and meditation can be beneficial for managing stress levels which can lead to muscle tension that contributes to rhabdomyolysis. Regular practice of yoga postures such as sun salutations or gentle stretching poses can also help improve flexibility in muscles and reduce inflammation in affected areas.

• Fresh fruits and vegetables: These provide essential vitamins, minerals, and antioxidants needed for healthy muscle function. Apples, bananas, and berries are particularly beneficial. Vegetables such as spinach, broccoli, and carrots are also high in nutrients.
• Lean proteins: Fish, chicken breast, lentils, and eggs are examples of lean proteins that supply the body with vital amino acids required to build muscle tissue.
• Whole grains: Whole grains such as oats, brown rice, quinoa, wheat germ and buckwheat are great sources of complex carbohydrates which will provide sustained energy throughout the day.
• Healthy fats: Healthy fats such as olive oil and avocados are beneficial for helping maintain healthy cholesterol levels which can help reduce inflammation in the body.

• High-fat and processed meals, like fried foods, red meats, and fast food, should be avoided.
• Limit intake of salty and sugary snacks and processed meats (e.g., sausage, bacon).
• Avoid alcohol and caffeine.
• Avoid stimulants like energy drinks and supplements with ephedrine or caffeine.

• Electrolyte replacement: Potassium, magnesium, and calcium should be replaced to maintain fluid balance in the body.
• Dialysis: Dialysis may be necessary to filter toxins out of the blood if kidney failure occurs due to rhabdomyolysis.
• Pain management: Medications can help relieve pain associated with rhabdomyolysis and its associated muscle injuries or conditions.
• Debridement: Removal of damaged and/or necrotic tissue from the area of injury.
• Fasciotomy: A surgical procedure to release pressure on the muscles by cutting through the fascia, which is the sheath of connective tissue that surrounds a muscle.
• Muscle Grafting: A procedure in which healthy muscle tissue is taken from another part of the body and transplanted into the area where the damaged tissue was removed.
• Muscle Transplantation: A procedure in which healthy muscle tissue is harvested from a donor and transplanted into the area where the damaged tissue was removed.

The best doctor to consult for Rhabdomyolysis is a medical doctor (MD) specializing in internal medicine, physical medicine and rehabilitation, or infectious disease.

Depending on the underlying cause of the condition, other specialists such as nephrologists (kidney specialists), neurologists (nervous system specialists), and orthopedic surgeons may also be involved in the care of patients with Rhabdomyolysis.

• NSAIDs: Pain medications such as opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage muscle aches and pains associated with rhabdomyolysis.
• Corticosteroids: Corticosteroids may be used to reduce inflammation and swelling of the muscles or kidneys that can result from rhabdomyolysis.
• Antibiotics: Antibiotics may be required in cases where an infection is causing the condition or contributing to its progression.

In general, complete healing might take anything from a few days to many weeks or even months.

During this time, patients will need to take rest and follow their doctor's instructions for medication, physical therapy, and lifestyle changes.

Although the symptoms of rhabdomyolysis can be effectively treated and managed with this supportive care, it is not known whether these treatments are permanent.

• Monitor vital signs, including electrolyte levels, regularly to detect any abnormalities.
• Ensure adequate fluid intake to replace lost fluids as a result of dehydration caused by rhabdomyolysis.
• Administer medications as prescribed to reduce muscle inflammation and pain and reduce the risk of further damage to the kidneys or other organs due to myoglobin in the bloodstream from muscle breakdown.
• Provide extra nutrition and vitamins such as potassium, magnesium and calcium to aid in muscle recovery and replenish lost electrolytes.
• Encourage rest and avoiding activities that can cause further strain on muscles until a full recovery is achieved
• Follow-up with a physician for regular check-ups to monitor progress of recovery.

Generally, hospitalization and medication costs range from around Rs 10,000 to Rs 50,000, while surgery can cost up to Rs 1 lakh or more.

Common side effects of rhabdomyolysis treatments include:

• Muscle pain and stiffness
• Fatigue
• Dark-colored urine
• Nausea and vomiting
• Fever
• Swollen joints
• Rapid heart rate
• Irregular heartbeat.
• Complications of rhabdomyolysis treatments may include kidney failure, electrolyte imbalances such as high levels of potassium or calcium in the blood, seizures and coma.
• Long-term effects may include muscle weakness and loss of function in the affected muscles as well as increased risk for infection.

If you have any symptoms of Rhabdomyolysis, you should see a doctor right away because it can lead to complications such as 'kidney failure, electrolyte imbalances, heart arrhythmias, and compartment syndrome,' and the treatment course can span from a few months to years depending on the extent of the condition.