How to Effectively Treat Episodes of Rhabdomyolysis

While rhabdomyolysis has been recognized as a consequence of crush injuries since the late 1800s, the most significant step toward finding the condition’s causes, mechanisms, and management strategies occurred when physicians who treated crush injuries from the 1941 London Blitz identified a link between rhabdomyolysis and renal impairment.

Rhabdomyolysis can be a serious and potentially life-threatening condition, as it is fatal in approximately 10% of cases. Today, rhabdomyolysis is also a rare yet potential side effect of statins.

In a review published in Neuromuscular Disorders, researchers from the University of Amsterdam defined rhabdomyolysis as the elevation of serum creatine kinase (CK) activity at least 10 times above the upper limit of normal levels, followed by a rapid decrease of serum CK levels close to normal values. During that time, patients might present with a wide variety of symptoms, including the traditional signs of myalgia, weakness, and pigmenturia.

In rhabdomyolysis, myoglobin mechanically obstructs the renal tubules and may lead to acute renal failure — the most common symptom after serum CK exceeds 16,000 IU/L, which consequently increases the likelihood of death.

According to the report authors, the goals of rhabdomyolysis treatment include:

• Preserving renal function
• Resolving compartment syndrome
• Restoring metabolic derangements
• Replacing volume to increase renal perfusion

The researchers also recommended that once rhabdomyolysis is controlled, the episode’s underlying cause must be treated.

The investigators noted that most patients experience only one episode of rhabdomyolysis, and they identified substance abuse, medication, trauma, and epileptic seizures as the most frequent causes. Those who experience recurrent rhabdomyolysis should be screened for genetic causes, especially neuromuscular disorders, the authors advised.