Rhabdomyolysis

Last reviewed: 28 Oct 2022
Last updated: 02 Nov 2022

Summary

Definition

History and exam

Key diagnostic factors

  • recent crush injury
  • prolonged immobilization
  • presence of other risk factors
  • muscular pain or weakness
More key diagnostic factors

Other diagnostic factors

  • general malaise
  • dark urine
  • muscular swelling
  • muscular tenderness
  • diminished peripheral pulse
  • prolonged capillary refill
Other diagnostic factors

Risk factors

  • trauma
  • alcohol
  • cocaine
  • amphetamine
  • phencyclidine
  • narcotics
  • diuretics
  • statins
  • salicylate toxicity
  • toxins
  • envenomation
  • inflammatory disorders
  • muscle hypoxia
  • genetic disorders
  • metabolic disorders
  • infection
  • increased body temperature
  • antipsychotics
More risk factors

Diagnostic investigations

1st investigations to order

  • serum creatine kinase (CK) level
  • serum electrolytes
  • renal function
  • liver function
  • CBC
  • coagulation studies
  • urine dipstick
  • urine microscopy
  • myoglobin levels
More 1st investigations to order

Investigations to consider

  • muscle biopsy
  • thyroid-stimulating hormone
  • erythrocyte sedimentation rate
  • antinuclear antibodies
  • toxicology screen
More investigations to consider

Treatment algorithm

ACUTE

crush injury and/or creatine kinase >5 times normal or >1000 IU/L

acute kidney injury refractory to initial therapy

Contributors

Authors

Chinmay Patel, MD, FASN

Nephrology Specialist

East Texas Kidney Specialists

Longview

TX

Disclosures

CP is an author of one reference cited in this topic.

Aditya Kadiyala, MD, MPH

Vice Chair

Department of Medicine

Division of Nephrology

University of Maryland

Charles Regional Medical Center

La Plata

MD

Disclosures

AK declares that he has no competing interests.

Acknowledgements

Dr Chinmay Patel and Dr Aditya Kadiyala would like to gratefully acknowledge Dr Mark Shapiro, Dr Courtney Sommer, and Dr Robert D. Mathis, previous contributors to this topic.

Disclosures

MS is an author of references cited in this topic. CS and RDM declare that they have no competing interests.

Peer reviewers

Timothy Albertson, MD, PhD, MPH

Chief

Division of Pulmonary and Critical Care Medicine

University of California, Davis

Sacramento

CA

Disclosures

TA declares that he has no competing interests.

  • Differentials

    • Myocardial infarction
    • Influenza
    • Fibromyalgia
    More Differentials
  • Guidelines

    • Rhabdomyolysis: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document
    • Clinical practice guidelines for exertional rhabdomyolysis: a military medicine perspective
    More Guidelines
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