Rhabdomyolysis is a serious situation characterized by the destruction of muscle fibers, which leads to the release of components present inside muscle cells into the bloodstream, such as calcium, sodium and potassium, myoglobin, creatinophosphinase and the piruvic transaminase enzyme (GPT). Large amounts of these substances in the blood can result in lack of strength, decreased urine, muscle fatigue, and kidney failure if not identified and treated.
As the released substances are toxic in high quantities, it is important that treatment is started as soon as possible, and it is recommended to go to the hospital or emergency room as soon as rhabdomyolysis is suspected. Rhabdomyolysis can occur due to the practice of strenuous physical activities of prolonged duration or as a consequence of a direct or indirect trauma to a muscle of the body, and it is also important to identify the cause for the treatment to be more directed.
The symptoms of rhabdomyolysis may vary according to the circulating amount of enzymes released from inside muscle cells, the most common symptoms being:
- Muscle pain;
- Lack of strength;
- Difficulty moving the legs or arms;
- Muscle stiffness;
- Joint pain;
- Urine in small amount and very dark, similar to the color of coca-cola.
In addition to these symptoms, more generic signs such as fever, nausea, abdominal pain, feeling tired, vomiting, confusion, and agitation may also arise. Since symptoms vary depending on the cause, as well as the organism of each person, it can be quite difficult to identify a case of rhabdomyolysis.
Therefore, in order to identify rhabdomyolysis and prevent complications, it is important to go to the hospital to perform specific tests to identify the disease, and then it is possible to start the most appropriate treatment.
How to confirm the diagnosis
The diagnosis of rhabdomyolysis is usually made by the doctor after evaluation of the symptoms and clinical history of the person. In addition, the doctor indicates the performance of blood and urine tests to check the amount of circulating electrolytes in the blood, as well as the concentration of myoglobin, creatinophoscokinase and PGT. Through the urine test, the doctor can also evaluate the amount of myoglobin, being important to know the extent of rhabdomyolysis and whether there are signs indicative of renal failure.
Myoglobin is one of the main tests requested by the doctor, because the greater the destruction of muscle fibers, the greater amount of myoglobin is released into the blood and urine, leaving it quite dark. Moreover, the greater the amount of myoglobin released, the greater the chance of renal tubules obstruction, which may result in tubular injury and, consequently, acute renal failure.
What causes rhabdomyolysis
Rhabdomyolysis usually occurs due to the practice of strenuous and prolonged physical activity, which results in excessive muscle stress. Other causes of rhabdomyolysis are:
- Serious accidents, such as high-rise falls or traffic accidents;
- Prolonged use of some medicines, especially antipsychotics or statins;
- Drug use, mainly cocaine, heroin or amphetamines;
- Prolonged immobilization because of fainting or illness;
- Infections, which can lead to the accumulation of toxins in the body, which is the main cause of rhabdomyolysis in children;
- Muscle diseases, such as myopathy and poliomyositis;
- Change in body temperature.
In addition, rhabdomyolysis can also occur as a consequence of excessive alcohol consumption, electric shock, metabolic diseases and stroke.
How treatment is done
When rhabdomyolysis has no complications, it usually resolves from a few days to weeks. However, in some cases it may be necessary for treatment to be carried out with the person admitted to the hospital in order to be given serum directly into the vein to avoid compsuch as dehydration or kidney failure caused by excess muscle residue in the blood.
In addition, it is important to identify the cause of rhabdomyolysis to start appropriate treatment if necessary. Thus, if it is being caused by the use of any medication, for example, it should be discontinued and replaced with another medicine according to medical advice.
The duration of treatment varies according to the cause and evolution of the patient, and during hospitalization it is necessary to be algesed to assess the amount of urine per day and to do other kidney tests to ensure that the function of the kidneys is not being affected. The patient is usually discharged when tests are normal and there is no risk of developing renal failure.
In the most severe cases, in which the kidneys begin to produce little urine, the doctor may prescribe dialysis to help kidney function, eliminating excess blood substances that may be hindering treatment.
The most serious and common complication of rhabdomyolysis is the appearance of kidney lesions, which can end up causing kidney failure. However, the presence of residues in the blood also leads to an increase in potassium and phosphorus levels in the body, which can end up affecting the functioning of the heart.
In rarer situations, another syndrome known as compartment syndrome may also arise, in which blood circulation is compromised in a region of the body, such as legs, arms or some muscles in the abdomen, causing tissue death.