Rhabdomyolysis

Rhabdomyolysis

In rhabdomyolysis, the voluntary (striated) muscles break down. The causes are varied, for example an injury to the muscles, autoimmune disease, alcohol or drug abuse.

What is rhabdomyolysis

In rhabdomyolysis, muscle fibers in skeletal muscle break down. This means that the muscles begin to dissolve. This releases large amounts of myoglobin. These reach the kidneys via the bloodstream. This can lead to significant damage up to and including acute kidney failure. Therefore, medical help is absolutely and immediately necessary. For about leukemia, please visit bittranslators.com.

There are different types: traumatic (physical), non-traumatic (non-physical), exercise-dependent and exercise-independent rhabdomyolysis. Stress-related rhabdomyolysis can result from training too hard, for example.

Causes

Various factors can trigger this disease, for example diseases such as malignant hyperthermia (life-threatening dysfunction of the skeletal muscles), acute toxic myopathy (muscle damage caused by toxins or medication), autoimmune diseases, metabolic disorders, drugs or ethanol. Ischemia (undersupply of tissue area with blood) or lack of oxygen are also among the triggers.

The most common causes are muscle overstretching, muscle air generation, and a crush injury. Bodybuilding circles warn again and again that very hard training, in which the muscles are severely overloaded, and a simultaneous lack of fluids can lead to acute muscle inflammation and thus to rhabdomyolysis.

The same applies if the training sessions take place too quickly one after the other. Toxic causes include cocaine and contagious causes include infection. Snakebite envenomation can lead to the breakdown of voluntary (striated) muscles, leading to rhabdomyolysis. Electrolyte imbalances can also lead to rhabdomyolysis.

Symptoms, Ailments & Signs

Swollen, tender, and painful muscles are the most obvious sign of rhabdomyolysis, while nonspecific symptoms include nausea, vomiting, diarrhea, fever, light- headedness, and severe fatigue. The disease can be accompanied by muscle pain, cramps and stiffness or swelling of the muscles with subsequent symptoms of paralysis.

At the latest when the urine turns red-brown, a doctor must be consulted immediately, as this is a sign of a very high myoglobin content in the blood and acute kidney failure. Myoglobin is a protein that is responsible for transporting oxygen within the muscles. If it cannot be filtered in the kidneys, the urine becomes colored. The symptoms of rhabdomyolysis should not be underestimated, as some of them are life-threatening.

Diagnosis & course of disease

Mild rhabdomyolysis is often identified by elevated levels of enzymes normally found in muscle, such as myoglobin, creatine kinase, and lactate dehydrogenase. When myoglobin levels are high, urine turns red-brown due to excretion of myoglobin through the kidneys. Diagnosis includes a detailed medical history, clinical examination, laboratory, electrophysiology, muscle biopsy with pathobiochemistry, muscle MR, and in some cases electron microscopy.

Complications

Rhabdomyolysis is a complication of various traumatic or non-traumatic processes. Injury or contusion of muscle tissue, as well as certain venoms (snake venom), infection, medication, drugs, or immunological disorders can lead to the breakdown of striated muscle. The most dangerous complication of rhabdomyolysis can develop due to increased excretion of myoglobin by the kidneys.

Myoglobin is formed when muscle tissue breaks down. It often causes the tubules in the kidneys to become blocked, with the iron contained in heme damaging the tubule cells. As a result, tubular tissue can die, which often causes acute kidney failure. Compartment syndrome can also occur, which is also a serious emergency.

The outflow disorders of venous blood due to swelling in the muscle area prevent the inflow of arterial blood, which leads to an undersupply of the muscles and the resulting further necrosis of muscle tissue. At the same time, hyperuricemia, which is characterized by an increase in the level of uric acid in the blood, often occurs. This can lead to the development of gout symptoms.

In addition, electrolyte disorders such as hyperkalemia, hyperphosphatemia and hypocalcaemia are not uncommon. These lead to cardiac arrhythmia, cardiac insufficiency, seizures, tetany, circulatory collapse and psychological impairments such as depression or anxiety disorders. Another complication is the dangerous drop in the platelet count, which at the same time leads to thrombosis and a strong tendency to bleed.

When should you go to the doctor?

Rhabdomyolysis should always be treated by a doctor. As a rule, this disease does not heal itself and in most cases there is also a significant deterioration in the general condition of the patient. The earlier the disease is recognized and treated, the higher the chance of success.

A doctor should be consulted for rhabdomyolysis if the affected person suffers from vomiting and nausea. Fever or severe pain in the muscles can also indicate the disease and should be examined by a doctor. In severe cases, paralysis of the muscles can also occur, so that the person concerned suffers from restrictions in movement and can no longer move around without problems. If the rhabdomyolysis is not treated, in the worst case it can also lead to kidney failure, which can be fatal. Rhabdomyolysis can be diagnosed by a general practitioner . However, it must be treated by different specialists.

Treatment & Therapy

Rhabdomyolysis usually develops over a long period of time and can sometimes be reversed if the trigger is stopped in good time. Although the breakdown of the muscles cannot be stopped from a therapeutic point of view, it will recede on its own after a while. Mild rhabdomyolysis that is caught early can be treated with a heavy intake of fluids and, if necessary, additional electrolytes.

Only possible damage to the kidneys and a lack of volume, since the damaged muscle binds fluid, must be counteracted in good time. With forced diuresis, damage to the kidneys can be avoided. In this case, several liters of liquid (physiological saline solution) are given to the affected person through infusions in order to accelerate the excretion of the myoglobin and to dilute the myoglobin that has accumulated in the urine.

If this is not enough, the pH value is also lowered by certain substances so that the myoglobin dissolves. In extreme cases, dialysis can remove the myoglobin from the blood. The kidneys are cleaned so that they can function independently again. The affected muscles must no longer be strained until all abnormalities have subsided. The most important goal of treatment is always to avoid acute kidney injury. If left untreated, rhabdomyolysis ends in fatal kidney failure in most cases. This results from the flooding of the decomposition products.

Prevention

In general, to prevent rhabdomyolysis, it is necessary to avoid subjecting the muscles to excessive stress, such as overtraining. In addition, it is essential to ensure that the body does not become dehydrated before, during and after sporting activities by drinking enough. Beginners should start slowly and gradually increase the training. Warming up the muscles is important.

If you are ill, you should avoid sport and consult a doctor if you are taking medication. Training in connection with alcohol or drugs is also strongly discouraged. Sufficient sleep and a healthy and balanced diet with lots of vitamins and minerals are also very important. Furthermore, you should not train in extreme temperatures, whether cold or hot.

The strain on the entire organism is too great in intense heat or when temperatures are below zero. Due to the extreme circumstances, the body cannot process training stimuli in a meaningful way. This can lead to incorrect reactions in the body, for example the breakdown of the striated muscles.

Aftercare

After the treatment of rhabdomyolysis, follow-up care is recommended for the patient, which is based on the previous therapy. If the muscle breakdown was triggered by an infection, for example, then follow-up examinations will check whether the pathogens could be eliminated from the patient’s organism. If an accident or trauma was responsible for the damage to the muscles, the main focus of the follow-up examinations is to check the healing process of the tissue.

If the kidneys have already been affected by the disease and are no longer working properly, they must regularly take medications that support kidney function and increase the production of urine. Regardless of the therapy, patients after rhabdomyolysis are given a nutrition plan and are supposed to strengthen their muscles through regular exercises.

Eating a balanced diet is thought to help support the body’s natural healing abilities and boost the immune system. The muscles that have been lost are rebuilt and strengthened with the help of light sporting exercises. It is very important, especially in the beginning, that the patients do not overstrain themselves. Otherwise, the muscles can be damaged again. There is a risk of recurrence of rhabdomyolysis. For this reason, care in rehabilitation therapy or adapted physiotherapy is recommended for the patients.

You can do that yourself

Once the diagnosis is established, treating physicians will attempt to eliminate the underlying cause of rhabdomyolysis to prevent the disease from getting worse. Furthermore, they will treat the disease according to its symptoms and, above all, try to prevent acute kidney failure.

Since the resulting tissue damage can only be eliminated by the body’s own repair measures, it makes sense for patients to strengthen their immune system as much as possible. Depending on their condition, they should do a lot of outdoor exercise. A healthy, stress-free lifestyle also supports the immune system. Patients should therefore not smoke, drink only little alcohol and eat healthily. To a healthy diet, Many vitamins and minerals come from fresh fruits and vegetables, whole grains and lean meats. Red meat, fatty sausage and sugar should be avoided. Plenty of rest, adequate sleep and drinking a lot – especially water – are very important measures to support the immune system.

Because many immune cells have been found in the intestine, the administration of probiotics is also recommended. This is a preparation with living microorganisms. They are said to multiply in the intestine and support the immune system there. Doctors with the additional qualification “naturopathy” as well as non- medical practitioners can make appropriate recommendations here.

Rhabdomyolysis