When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Rhabdomyolysis

Last reviewed: 3 Apr 2025
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
Full details

Other diagnostic factors

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

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
Full details

Diagnostic tests

1st tests to order

  • serum creatine kinase (CK) level
  • serum electrolytes
  • renal function
  • liver function
  • CBC
  • coagulation studies
  • urine dipstick
  • urine microscopy
  • myoglobin levels
Full details

Tests to consider

  • muscle biopsy
  • thyroid-stimulating hormone
  • erythrocyte sedimentation rate
  • antinuclear antibodies
  • toxicology screen
Full details

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Kodadek L, Carmichael Ii SP, Seshadri A, et al. Rhabdomyolysis: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document. Trauma Surg Acute Care Open. 2022;7(1):e000836.Full text  Abstract

The Renal Association (UK). Clinical practice guideline: acute kidney injury (AKI). Aug 2019 [internet publication].Full text

Sawhney JS, Kasotakis G, Goldenberg A, et al. Management of rhabdomyolysis: a practice management guideline from the Eastern Association for the Surgery of Trauma. Am J Surg. 2022 Jul;224(1 pt a):196-204.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • 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
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer