When an injury causes a person's muscles to break down rapidly, toxins can leak into the blood causing a condition called rhabdomyolysis. In extreme cases, the toxins can lead to kidney failure. Dr. Frank P. Dawson, medical director at the MedStar Franklin Square Sports Medicine Departments of Pediatrics and Orthopedic Surgery, sometimes sees the condition in his patients who are athletes. He discusses how to treat and prevent rhabdomyolysis.
What is rhabdomyolysis?
If an athlete hears the word, rhabdomyolysis, they shouldn't take it lightly. It is a condition that occurs when a traumatic injury, such as crushing blow to a muscle, causes death or damage in the muscle tissue. The tissue breaks down and releases multiple toxic substances into the blood. The protein myoglobin is the most common. Once released, it can build up and cause blockages in the kidney vessels that if severe enough, will cause the kidneys to shut down. Another possibility is the release of creatine kinase which can also put a damaging strain on kidneys.
In minor cases of rhabdomyolysis, the symptoms may not be so noticeable but a blood test may reveal the condition. Severe cases of it however, can be life threatening.
Damaged muscle tissues also retain body fluids. This can cause dehydration as well as reduce the flow of blood to the kidney, thereby increasing the risk of organ damage.
The complications associated with rhabdomyolysis depend on the severity of the case and on several individual factors. Minor cases may not cause any noticeable symptoms and might only be spotted with blood serum tests. Severe cases often cause severe muscle pain, however, and can be life-threatening.
What causes the disorder?
It is typically caused by athletic participation in an extreme heat environment. However rhabdomyolysis can occur in other situations when a patient has an underlying medical condition. These conditions can be as simple as a viral illness or something chronic like the sickle cell trait. Most times when I see this condition, it is the result of participating in an iron man triatholon or a marathon. However it also occurs as the result of physical trauma, or a crushing injury to the body. I've seen it during the summer or early fall months during common activities such as football or track practice.
What are the symptoms?
Symptoms of rhabdomyolysis include severe muscle pain and aches, difficulty walking or running and muscle weakness followed by red or dark urine. Sometimes a patient will go to the emergency room complaining of muscle pain and brown urine.
It's not unusual for a sports medicine physician on site at an athletic event to suspect that someone experiencing muscle pain has rhabdomyolysisif it's very hot out, and there is a strong endurance element of the sport. An athlete may complain of muscle pain and weakness, and with the other factors mentioned, a physician would have the patient transported to the emergency room. In the emergency department, a blood test will reveal if blood toxins are at a dangerous level. The enzymes that break out of the injured muscles are toxic once it enters the blood.
How is rhabdomyolysis treated?
Typically, a patient with rhabdomyolysis simply requires rest and fluids until the level of enzymes in the blood resume to a normal level. More severe conditions can result in a hospital admission with IV fluids.
What more serious problems can rhabdomyolysis lead to?
Severe cases of the rhabdomyolysis can result in multi-system organ failure because of the stress put on the kidneys. The job of the kidneys is to filter blood. Once enzymes caused by the breakdown of the muscles enter the blood stream, they pass through the kidneys, which results in an enormous amount of stress as they work to filter them. The kidneys may be unable to keep up, and a result of that is kidney failure. The kidney failure means dangerous levels of toxins in the blood then are free to pass to the liver, brain. This could possibly be followed by multiple organ system failure and death.