|  | Cancer | Leukemia

Rhabdomyolysis: Causes, Recognition, and Emergency Management

Muscle Breakdown Syndrome

Rhabdomyolysis = necrosis of skeletal muscle → release of myoglobin, CK, K⁺, phosphate, urate into circulation → risk of acute kidney injury (AKI), arrhythmias, compartment syndrome, DIC.

Major Etiologies

  • Trauma/Crush Injury
  • Exertional: Unaccustomed intense exercise, heat, military/athletic training.
  • Drugs/Toxins: Statins (esp. + fibrates), cocaine, amphetamines, heroin, alcohol, corticosteroids.
  • Infections: Influenza, Legionella, sepsis.
  • Metabolic/Endocrine: Diabetic ketoacidosis, thyroid storm, electrolyte extremes.
  • Genetic: Metabolic myopathies (McArdle, CPT II), malignant hyperthermia susceptibility.

Classic Triad (Not Always Present)

  • Muscle pain/tenderness/swelling
  • Dark "tea-colored" urine (myoglobinuria)
  • Weakness

Diagnosis

CK >5x ULN (often 10,000–100,000+); myoglobinuria (dipstick + heme+ but RBC-); electrolytes, renal function, urinalysis.

Emergency Treatment

  • Aggressive IV Fluids: Normal saline 1–1.5 L/hr → target urine output 200–300 mL/hr.
  • Alkalinization: Sodium bicarbonate if urine pH <6.5 (reduces myoglobin precipitation).
  • Monitor: CK q12–24h, electrolytes, renal function, compartment pressures.
  • Dialysis if AKI refractory.

Early fluid resuscitation is the single most effective intervention to prevent AKI.

Leukemia - Related Articles