Last reviewed: 25 Oct 2020
Last updated: 29 Nov 2019



History and exam

Key diagnostic factors

  • recent crush injury
  • prolonged immobilization
  • presence of other risk factors
  • muscular pain

Other diagnostic factors

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

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

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


Clinical Professor of Nephrology

University of Pikeville

Kentucky College of Osteopathic Medicine

Pikeville Medical Center




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

Vice Chair

Department of Medicine 

Division of Nephrology

University of Maryland

Charles Regional Medical Center

La Plata



AK declares that he has no competing interests.

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.


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

Peer reviewersVIEW ALL


Division of Pulmonary and Critical Care Medicine

University of California, Davis




TA declares that he has no competing interests.

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