Rhabdomyolysis causes: Difference between revisions

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==Overview==
==Overview==
Injuries leading to rhabdomyolysis can be due to mechanical, physical, and chemical causes.
The aetiological spectrum of rhabdomyolysis is extensive in many cases, multiple muscle insults are usually needed to produce rhabdomyolysis unless an underlying [[myopathy]] is present. The most common causes of rhabdomyolysis in adults are [[illicit drugs]], [[alcohol abuse]], [[medication]], [[myopathy|muscle diseases]], [[trauma]], [[neuroleptic malignant syndrome]] (NMS), [[seizures]] and [[immobility]], Whereas in paediatric patients, the most common causes are [[myositis|viral myositis]], [[trauma]], [[connective tissue disorders]], [[exercise]], and [[drug overdose]].<ref name="pmid19841484">Khan FY (2009) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19841484 Rhabdomyolysis: a review of the literature.] ''Neth J Med'' 67 (9):272-83. PMID: [https://pubmed.gov/19841484 19841484]</ref>
__NOTOC__
 
==Causes==
==Causes==


===Life-Threatening Causes===
===Life-Threatening Causes===
 
*[[Burns]]
 
*[[Crush injury]]
*[[Electrical injury]]
*[[Exertional Heat stroke]]
*[[Compartmental syndrome]]
*[[Malignant hyperthermia]]
*[[Neuroleptic malignant syndrome]]
*[[Electrolyte abnormalities]] such as [[Hypokalemia]]


===Common Causes===
===Common Causes===
 
*[[Burns]]
 
*[[crush injury]]
*Long-lasting muscle compression in [[Coma]] patients, under the influence of [[alcohol]], medication or [[illicit drugs]]
*[[Electrical injury]]
*[[Snake venom]]
*[[Heat stroke]]
*[[Seizures]]


===Causes by Pathophysiology===
===Causes by Pathophysiology===
{| class="wikitable"
|-
! style="width: 35%;" | '''Mechanical Causes'''
! style="width: 30%;" | '''Physical causes'''
! style="width: 35%;" | '''Chemical causes'''
|-
| valign = top |
*[[Burns]]
*[[Choreoathetosis]]
*[[Compartment syndrome]]
*Compression by a [[tourniquet]] left for too long
*[[Crush injury]]
*[[Exertion|Excessive exertion]]
*[[Seizure|Intractable convulsions]]
*Local muscle compression due to [[coma]]tose states
*Rigidity due to [[neuroleptic malignant syndrome]]
*[[Surgery]]
| valign = top |
*[[Electric current]]
*Extreme physical exertion (although most heavy exercise does not cause kidney damage)<ref>{{cite journal |author=Clarkson P, Kearns A, Rouzier P, Rubin R, Thompson P |title=Serum creatine kinase levels and renal function measures in exertional muscle damage |journal=Med Sci Sports Exerc |volume=38 |issue=4 |pages=623-7 |year=2006 |pmid=16679975}}</ref>
*High [[fever]] or [[hyperthermia]]
| valign = top |
*[[Alcohol|Alcoholic beverage]]
*[[Anoxia]] of the muscle (e.g., [[Bywaters' syndrome]], toxin- and drug-related)
*[[Antibiotics]]
*Any drug that directly or indirectly impairs the production or use of [[adenosine triphosphate]] (ATP) by skeletal muscle, or increases energy requirements so as to exceed ATP production, can cause rhabdomyolysis.<ref name="pmid17344731">{{cite journal |author=Larbi EB |title=Drug-induced rhabdomyolysis |journal=Annals of Saudi medicine |volume=18 |issue=6 |pages=525–30 |year=1998 |pmid=17344731 |doi= |url=http://www.kfshrc.edu.sa/annals/186/98-069.html}}</ref>
*Certain mushrooms like ''[[Tricholoma equestre]]''
*[[Electrolyte abnormalities]]
*[[Endocrinopathy]]
*[[H1 antagonist|First-generation H1-receptor antagonists]] (e.g., [[diphenhydramine]])
*Heritable muscle enzyme deficiencies
*[[Metabolic disorder]]s,
*[[Skeletal muscle relaxant]] that are consumed in overdose are rarely associated with this condition.<ref name="pmid16846511">{{cite journal |author=Chabria SB |title=Rhabdomyolysis: a manifestation of cyclobenzaprine toxicity |journal=Journal of occupational medicine and toxicology (London, England) |volume=1 |issue= |pages=16 |year=2006 |pmid=16846511 |doi=10.1186/1745-6673-1-16 |url=http://www.occup-med.com/content/1/1/16}}</ref>
*[[Statin]]
*Various animal toxins
* [[Theophylline]]
|}
{{familytree/start}}
{{familytree/start}}
{{familytree | | | | | | | | | | B01 | | | | | |B01=Rhadomyolysis}}
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{{familytree | | | | | |!| | E01 | | | | | | E02 | | |!|E01=Non - Traumatic Exertional Rhadomyolysis in a '''Normal Muscle'''|E02=Non - Traumatic Exertional Rhadomyolysis in an '''Abnormal Muscle'''}}
{{familytree | | | | | |!| | E01 | | | | | | E02 | | |!|E01=Non - Traumatic Exertional Rhadomyolysis in a '''Normal Muscle'''|E02=Non - Traumatic Exertional Rhadomyolysis in an '''Abnormal Muscle'''}}
{{familytree | | | | | |!| | |!| | | | | | | |!| | | |!| | | | | | | | | | |}}
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{{familytree | | | | | |!| | |`|.| | | | | |,|'| | | |!| | | | | | | | | | |}}
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{{familytree | | | | | |!| | | |!| | | | | |!| | | | |!| | | | | | | | | | |}}
{{familytree |boxstyle=text-align: left; | | | | | F01 | | F02 | | | | | |!| | | F03 | | | | | | | | | |F01=❑[[Crush injury]]<br> ❑[[Coma]]<br> ❑[[Post ictal state]]<br> ❑[[Post operative complications|Post - Operative Surgical trauma]]<br> ❑[[Electrical Injury]] ❑[[Compartment Syndrome]]<br> ❑[[Immobility|Immobilizaion]]|F02=❑[[Hyperthermia|Exertional Heat Stroke]]<br> ❑[[Sickle cell trait]]<br> ❑[[Hyperkinetic States]] Such as<br>*[[Grand mal Seizures]]<br> *[[Delirium tremens]]<br> *[[Psychosis|Psychotic agitation]]<br> *[[Amphetamine|Amphetamine Overdose]]|F03=❑Drugs and toxins<br> ❑[[Infections]]<br> ❑[[Electrolyte abnormalities]]<br> ❑[[Endocrinology|Endocrinopathies]]<br> ❑[[Polymyositis|Inflammatory myopathies]]<br> ❑Miscellaneous}}
{{familytree |boxstyle=text-align: left; | | | | | F01 | | F02 | | | F03 | | | | F04 | | | | | | | | | |F01=❑ [[Crush injury]]<br> ❑ [[Coma]]<br> ❑ [[Post ictal state]]<br> ❑ [[Post operative complications|Post - Operative Surgical trauma]]<br> ❑ [[Electrical Injury]]<br> ❑ [[Compartment Syndrome]]<br> ❑ [[Immobility|Immobilizaion]]|F02=❑ [[Hyperthermia|Exertional Heat Stroke]]<br> ❑ [[Sickle cell trait]]<br> ❑ [[Hyperkinetic States]] Such as<br>* [[Grand mal Seizures]]<br> * [[Delirium tremens]]<br> * [[Psychosis|Psychotic agitation]]<br> * [[Amphetamine|Amphetamine Overdose]]|F03=❑ [[Myopathy|Metabolic myopathies]]<br> ❑ [[Myopathy|Mitochondrial myopathies]]<br> ❑ [[Malignant hyperthermia]]<br> ❑ [[Neuroleptic malignant syndrome]]|F04=❑ Drugs and toxins<br> ❑ [[Infections]]<br> ❑ [[Electrolyte abnormalities]]<br> ❑ [[Endocrinology|Endocrinopathies]]<br> ❑ [[Polymyositis|Inflammatory myopathies]]<br> ❑ Miscellaneous}}  
{{familytree | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{familytree | | | | | | |,|-|-|-|v|-|-|-|-|-|+|-|-|-|-|.| | | | | | | | | |}}
{{familytree | | | | | | |!| | | |!| | | | | |!| | | | |!|}}
{{familytree | | | | | | G01 | | G02 | | | | G03 | | | G04 |G01='''Metabolic myopathies'''|G02='''Mitochondrial myopathies'''|G03='''Malignant hyperthermia'''|G04='''Neuroleptic malignant syndrome''' }}
{{familytree | | | | | | |!| | | |!| | | | | |!| | | | |!|}}
{{familytree/end}}
{{familytree/end}}
{| class="wikitable"
{| class="wikitable"
! colspan="4" |Non-Traumatic Exertional Rhabdomyolysis in an Abnormal Muscle
! colspan="4" |Non-Traumatic Exertional Rhabdomyolysis in an Abnormal Muscle
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*[[Cabergoline]]
*[[Cabergoline]]
|}
|}
{| class="wikitable"
 
 
{| border="2" cellpadding="5" cellspacing="0" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;" width="75%"
! colspan="2" |'''Non-Traumatic Non-Exertional Causes'''
|-
|{{Center|'''Infections'''}}
| '''''Viral infections''''' :<br> [[Adenovirus]], [[Coxsackievirus]], [[Cytomegalovirus]], [[Echovirus]] , [[Epstein-Barr]] , [[Herpes simplex]], [[Human immunodeficiency virus]], [[Influenza|Influenza A and B]], [[Parainfluenza]]<br>'''''Bacterial infections''''' :<br> [[Pyomyositis|Bacterial pyomyositis]], [[Coxiella burnetii]]([[Q fever]]), [[E. coli]], [[Ehrlichiosis]],[[Plasmodium falciparum|Falciparum malaria]], [[Legionella]], [[Leptospirosis]], [[Mycoplasma pneumoniae]], [[Salmonella]], [[Staphylococcal infection]], [[Streptococcus]], [[Tularemia]]
|-
|{{Center|'''Electrolyte abnormalities'''}}
| [[Hypokalemia]], [[Hypophosphatemia]]
|-
|{{Center|'''Endocrinopathies'''}}
| [[Hypothyroidism]], [[Diabetic ketoacidosis]] , [[Hyperglycemia|Non-ketotic hyperglycemia]]
|-
|-
! style="width: 20%;" | '''Drugs and toxins'''
|{{Center|'''Inflammatory myopathies'''}}
! style="width: 20%;" | '''Infections'''
| [[Dermatomyositis]], [[Polymyositis]]
! style="width: 15%;" | '''Electrolyte abnormalities'''
! style="width: 15%;" | '''Endocrinopathies'''
! style="width: 15%;" | '''Inflammatory myopathies'''
! style="width: 15%;" | '''Miscellaneous'''
|-
|-
| valign = top |
|{{Center|'''Miscellaneous'''}}
'''DRUGS CAUSING DIRECT MYOTOXICITY'''
| [[Alcoholism]], [[Baclofen|Baclofen withdrawl]], [[Capillary leak syndrome]], [[Status asthmaticus]]
*[[Alcohol]]
|}
*[[Amphetamines]]
 
*[[Antihistamines]]
=== Causes by Alphabetical Order ===
*[[Antimalarial drug|Antimalarial drugs]]
{{columns-list|  
*[[Antipsychotic drugs]]
*[[Antipsychotic drugs]]
*[[Antiretroviral drugs]]
*[[Chemotherapeutic agents]]
*[[Chloroquine]]
*[[Cocaine]]
*[[Colchicine]]
*[[Colchicine]]
*[[D-Lsergic Acid Diethylamide]] (LSD)
*[[Gemcitabine]]
*[[Gemfibrozil]]
*[[Glucocorticoids]]
*[[Heroin]]
*[[Hydroxychloroquine]]
*[[Ipecac syrup]]
*[[Methadone]]
*[[Selective serotonin reuptake inhibitors]]
*[[Statins]]
*[[Zidovudine]]
'''DRUGS CAUSING AN IMMUNOLOGICALLY MEDIATED MYOPATHY'''
*[[Interferon alpha]]
*[[Ipilimumab]]
*[[Penicillamine]]
*[[Statins]]
*[[Tumour necrosis factor|Tumor necrosis factor inhibitors]]
'''Toxins'''
*[[Carbon monoxide]]
*[[Mushroom poison]]
*[[Snake venoms]]
| valign = top |
'''Viral infections'''
*[[Adenovirus]]
*[[Adenovirus]]
*[[Alcoholism]]
*[[Alpha-methylacyl-CoA racemase|Alpha-methylacyl-coa racemase (amacr) deficiency]]
*[[Parkinson's disease medical therapy|Anti parkison drug withdrawl]]
*[[Antiemetic|Antiemetic agents]]
*[[Aripiprazole]]
*[[Asenapine maleate]]
*[[Baclofen|Baclofen withdrawl]]
*[[Pyomyositis|Bacterial pyomyositis]]
*[[Barth syndrome]]
*[[Adenosine triphosphate|Brody myopathy]] ([[Adenosine triphosphate|calcium adenosine triphosphatase deficiency]])
*[[Bromocriptine]]
*[[Burns]]
*[[Cabergoline]]
*[[Capillary leak syndrome]]
*[[Carnitine deficiency]]
*[[Carnitine palmitoyltransferase deficiency]]
*[[Chlorpromazine]]
*[[Chronic Progressive External Ophthalmoplegia]]
*[[Clozapine]]
*[[Coma]]
*[[Compartment syndrome]]
*[[Coxiella burnetii]] ([[Q fever]])
*[[Coxsackievirus]]
*[[Coxsackievirus]]
*[[Crush injury]]
*[[Cytomegalovirus]]
*[[Cytomegalovirus]]
*[[Echovirus]]
*[[Neuromuscular-blocking drugs|Depolarising neuro-muscular blocker]]
*[[Epstein-Barr]]  
*[[Dermatomyositis]]
*[[Herpes simplex]]
*[[Desflurane]]
*[[Human immunodeficiency virus]]  
*[[Diabetic ketoacidosis]]
*[[Influenza|Influenza A and B]]
*[[Domperidone]]
*[[Parainfluenza]]  
*[[Droperidol]]
'''Bacterial infections'''
*[[Pyomyositis|Bacterial pyomyositis]]
*[[Coxiella burnetii]]([[Q fever]])
*[[E. coli]]
*[[E. coli]]
*[[Echovirus]]
*[[Ehrlichiosis]]
*[[Ehrlichiosis]]
*[[Electrical injury]]
*[[Electrolyte abnormalities]]
*[[Endocrinology|Endocrinopathies]]
*[[Epstein-Barr|Epstein-barr ]]
*[[Plasmodium falciparum|Falciparum malaria]]
*[[Plasmodium falciparum|Falciparum malaria]]
*[[Fluphenazine]]
*[[GRACILE syndrome]]
*[[Haloperidol]]
*[[Halothane]]
*[[Herpes simplex]]
*[[Human immunodeficiency virus]]
*[[Hypokalemia]]
*[[Hypophosphatemia]]
*[[Hypothyroidism]]
*[[Iloperidone]]
*[[Immobility|Immobilizaion]]
*[[Polymyositis|Inflammatory myopathies]]
*[[Influenza|Influenza A and B]]
*[[Isoflurane]]
*[[Myopathy|Isolated myopathy]]
*[[Kearns-Sayre syndrome]]
*[[Lactate dehydrogenase|Lactate dehydrogenase deficiency]]
*[[L-dopa]]
*[[Legionella]]
*[[Legionella]]
*[[Leigh's disease]]
*[[Leptospirosis]]
*[[Leptospirosis]]
*[[LPIN1|Lipin-1 deficiency]]
*[[Long-chain acyl-CoA dehydrogenase deficiency]]
*[[Loxapine]]
*[[Malignant hyperthermia]]
*[[Malignant hyperthermia]] susceptibility caused by ryr1 gene mutations
*[[Myopathy|Metabolic myopathies]]
*[[Metoclopramide]]
*[[Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes]] (MELAS)
*[[Mitochondrial myopathy|Mitochondrial myopathies]]
*[[Mycoplasma pneumoniae]]
*[[Mycoplasma pneumoniae]]
*[[Myoadenylate deaminase deficiency]]
*[[Myoclonic epilepsy with ragged red fibers]] (MERRF)
*[[Glycogen storage disease type V|Myophosphorylase deficiency]]
*[[Neuroleptic malignant syndrome]]
*[[Neuroleptics]]
*[[Hyperglycemia|Non-ketotic hyperglycemia]]
*[[Olanzapine]]
*[[Paliperidone]]
*[[Parainfluenza]]
*[[Perphenazine]]
*[[Phosphofructokinase|Phosphofructokinase deficiency]]
*[[Phosphoglycerate kinase|Phosphoglycerate kinase deficiency]]
*[[Phosphoglycerate mutase|Phosphoglycerate mutase deficiency]]
*[[Phosphorylase kinase|Phosphorylase kinase deficiency]]
*[[Polymyositis]]
*[[Post operative complications|Post - operative surgical trauma]]
*[[Post ictal state]]
*[[Prochlorperazine]]
*[[Promethazine]]
*[[Quetiapine]]
*[[Risperidone]]
*[[Salmonella]]
*[[Salmonella]]
*[[Mitochondrial myopathy|Severe encephalomyopathy of infancy or childhood]]
*[[Sevoflurane]]
*[[Short-chain acyl-coenzyme A dehydrogenase deficiency]]
*[[Staphylococcal infection]]
*[[Staphylococcal infection]]
*[[Status asthmaticus]]
*[[Streptococcus]]
*[[Streptococcus]]
*[[Succinylcholine]]
*[[Thioridazine]]
*[[Thiothixene]]
*[[Trifluoperazine]]
*[[Tularemia]]
*[[Tularemia]]
| valign = top |
*[[Volatile anaesthetic|Volatile anesthetic agent]]
*[[Hypokalemia]]
*[[Ziprasidone]]
*[[Hypophosphatemia]]
}}
| valign = top |
*[[Hypothyroidism]]
*[[Diabetic ketoacidosis]]
*[[Hyperglycemia|Non-ketotic hyperglycemia]]
| valign = top |
*[[Dermatomyositis]]
*[[Polymyositis]]
| valign = top |
*[[Alcoholism]]
*[[Baclofen|Baclofen withdrawl]]
*[[Capillary leak syndrome]]
*[[Status asthmaticus]]
|}


==References==
==References==

Latest revision as of 22:39, 10 January 2020

Rhabdomyolysis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Overview

The aetiological spectrum of rhabdomyolysis is extensive in many cases, multiple muscle insults are usually needed to produce rhabdomyolysis unless an underlying myopathy is present. The most common causes of rhabdomyolysis in adults are illicit drugs, alcohol abuse, medication, muscle diseases, trauma, neuroleptic malignant syndrome (NMS), seizures and immobility, Whereas in paediatric patients, the most common causes are viral myositis, trauma, connective tissue disorders, exercise, and drug overdose.[1]

Causes

Life-Threatening Causes

Common Causes

Causes by Pathophysiology

 
 
 
 
 
 
 
 
 
Rhadomyolysis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Traumatic or Muscle Compression
 
 
 
 
 
 
 
 
Non - Traumatic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-Traumatic
Exertional
 
 
 
 
 
Non-Traumatic
Non-Exertional
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non - Traumatic Exertional Rhadomyolysis in a Normal Muscle
 
 
 
 
 
Non - Traumatic Exertional Rhadomyolysis in an Abnormal Muscle
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Crush injury
Coma
Post ictal state
Post - Operative Surgical trauma
Electrical Injury
Compartment Syndrome
Immobilizaion
 
Exertional Heat Stroke
Sickle cell trait
Hyperkinetic States Such as
* Grand mal Seizures
* Delirium tremens
* Psychotic agitation
* Amphetamine Overdose
 
 
Metabolic myopathies
Mitochondrial myopathies
Malignant hyperthermia
Neuroleptic malignant syndrome
 
 
 
❑ Drugs and toxins
Infections
Electrolyte abnormalities
Endocrinopathies
Inflammatory myopathies
❑ Miscellaneous
 
 
 
 
 
 
 
 
 
Non-Traumatic Exertional Rhabdomyolysis in an Abnormal Muscle
Metabolic myopathies Mitochondrial myopathies Malignant hyperthermia Neuroleptic malignant syndrome

Disorders of glycogenolysis

Disorders of glycolysis

Disorders of lipid metabolism

Disorders of purine metabolism

Other defects

Volatile anesthetic agent

Depolarising Neuro-Muscular Blocker

Neuroleptics

Antiemetic agents

Anti Parkison drug withdrawl


Non-Traumatic Non-Exertional Causes
Infections
Viral infections :
Adenovirus, Coxsackievirus, Cytomegalovirus, Echovirus , Epstein-Barr , Herpes simplex, Human immunodeficiency virus, Influenza A and B, Parainfluenza
Bacterial infections :
Bacterial pyomyositis, Coxiella burnetii(Q fever), E. coli, Ehrlichiosis,Falciparum malaria, Legionella, Leptospirosis, Mycoplasma pneumoniae, Salmonella, Staphylococcal infection, Streptococcus, Tularemia
Electrolyte abnormalities
Hypokalemia, Hypophosphatemia
Endocrinopathies
Hypothyroidism, Diabetic ketoacidosis , Non-ketotic hyperglycemia
Inflammatory myopathies
Dermatomyositis, Polymyositis
Miscellaneous
Alcoholism, Baclofen withdrawl, Capillary leak syndrome, Status asthmaticus

Causes by Alphabetical Order

References

  1. Khan FY (2009) Rhabdomyolysis: a review of the literature. Neth J Med 67 (9):272-83. PMID: 19841484

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