Rhabdomyolysis (HB)

Rhabdomyolysis (commonly referred to as rhabdo) is a very serious and potentially life-threatening condition caused by the destruction of damaged skeletal muscle. Any form of direct muscle damage or any condition that causes muscle damage can cause rhabdo. One of the most important end goals when treating rhabdomyolysis is avoiding acute kidney injury.

The most common cause is due to direct trauma to skeletal muscle either from blunt trauma impacts or prolonged overexertion of a muscle group (like the repetitive action of cutting line four days in a row). This leads to the loss of perfusion to a localized area (ischemia) that if not corrected will lead to tissue death (infarction). Remember, sugar, oxygen, and water under pressure to the cells equals perfusion. If cells don’t get perfused they can’t survive.

There are other causes or conditions that can increase the likelihood or intensity of rhabdo. The causes include pre-existing medical conditions (diabetes or other endocrine disorders), hyponatremia, severe dehydration, electrolyte imbalance, drug and alcohol use, hypothermia/hyperthermia, and complications after a lightning strike. Compartment syndrome can also cause rhabdo and rhabdo can lead to a compartment syndrome.

The end result is the release of muscle fibers and toxins from the breakdown of the cells into the bloodstream that causes numerous problems, especially to the kidneys.

Prevention

Hydration and rest are important strategies for preventing rhabdo. Also, ease back into heavy workloads if you have been sedentary for a period of time.

Signs and Symptoms

It can be very difficult to diagnose in the field due to the wide variety of signs and symptoms that are present in patients. Not all patients will present the same sets of symptoms. Even in the hospital setting, it can be a difficult diagnosis without getting specific lab tests. Getting a good patient history is very important.
Some classic signs and symptoms are:

• Dark urine or decreased urine output.
• Muscle pain, weakness, and or tenderness especially in the shoulders, thighs, and kidney area.
• Generalized weakness.

These are not absolute, some studies suggest that less than 10% of patients have dark urine and 50% have no complaints of muscle pain.

Other signs and symptoms that may be present include:

• Nausea and vomiting.
• Fever.
• Increased heart rate.
• Reported pain or cramping as “unique”, “different”, or “out of proportion”.

Treatment

The best treatment for a suspected case of rhabdo is early recognition and hydration. If you’re not sure if it’s rhabdo then treat it like it is. Give them water and get them to a hospital as soon as possible to get lab tests. Although there is little we can do in the field to fix this problem, speedy diagnosis and hydration can have a big effect on the outcome of the patient.