Rhabdomyolysis is a serious medical condition that results from the breakdown of skeletal muscle tissue. When muscle fibers are damaged, they release their contents—including proteins like myoglobin—into the bloodstream. These substances can cause complications in the body, particularly in the kidneys, leading to acute kidney injury or even kidney failure if not treated promptly.

The term "rhabdomyolysis" comes from Greek roots meaning "striated muscle breakdown." Often referred to simply as "rhabdo," the condition can develop due to trauma, strenuous exercise, drug use, infections, or metabolic disorders. While some cases are mild and resolve with rest and hydration, others can be life-threatening and require hospitalization.

Key symptoms

Symptoms of rhabdomyolysis vary widely, from mild to severe, and not all patients present the classic triad. However, some hallmark signs include:

  • Severe muscle pain or cramping, especially in the calves, thighs, or lower back

  • Muscle weakness and fatigue, making normal tasks difficult

  • Dark-colored urine, often described as tea-colored or cola-like

Other symptoms that may occur due to complications include:

  • Fever

  • Nausea or vomiting

  • Rapid heart rate (tachycardia)

  • Swelling in the limbs

  • Decreased or absent urine output

Electrolyte disturbances caused by muscle breakdown can also lead to:

  • Heart palpitations

  • Seizures

  • Muscle spasms or twitching

Recognizing symptoms early can be crucial for preventing serious complications.

What causes it?

Rhabdomyolysis occurs when muscle tissue breaks down rapidly, releasing internal components like creatine kinase (CK) and myoglobin into the bloodstream. These byproducts can overwhelm the kidneys and disrupt vital systems.

Primary causes include:

  • Trauma: Crush injuries, accidents, or prolonged compression of muscles.

  • Intense physical exertion: Overexertion during strenuous workouts, especially in untrained individuals or extreme conditions.

  • Drug use: Statins, antipsychotics, antihistamines, alcohol, cocaine, and heroin.

  • Infections: Influenza, strep, mono, salmonella.

  • Heat-related illness: Heat stroke or working in high temperatures without hydration.

  • Prolonged immobilization: Being unconscious or bedridden for extended periods.

  • Genetic or metabolic disorders: Muscular dystrophy, mitochondrial disorders, or sickle cell disease.

In many cases, multiple factors contribute simultaneously—for example, a person exercising intensely while dehydrated and taking certain medications.

Risk factors

Several factors can increase the likelihood of developing rhabdomyolysis:

  • Age over 60

  • Unaccustomed high-intensity exercise

  • Use of medications known to affect muscles

  • Pre-existing muscle or metabolic disorders

  • Dehydration

  • Electrolyte imbalances

  • Exposure to heat or prolonged sun

  • Substance abuse

Understanding and managing these risk factors can help prevent rhabdo.

Diagnostic process

Diagnosis begins with a thorough medical history and physical exam. If rhabdomyolysis is suspected, several tests help confirm the condition and assess severity.

Key diagnostic tests include:

  • Creatine kinase (CK): High CK levels in the blood are the most definitive sign. Levels five times the normal range are considered diagnostic.

  • Myoglobin in urine: Indicates muscle breakdown but may only be detectable for a short time.

  • Blood tests: Complete blood count (CBC), metabolic panel to assess kidney function and electrolyte balance.

  • Electrocardiogram (ECG): Checks for cardiac abnormalities caused by electrolyte imbalances.

If no clear cause is found, genetic testing or additional metabolic screening may be required.

Treatment options

Treatment depends on the severity of the condition. In mild cases, rest and hydration at home may suffice. More serious cases require hospitalization.

Standard treatments include:

  • Intravenous (IV) fluids: Critical for flushing out muscle proteins and preventing kidney damage.

  • Electrolyte management: Correct imbalances, particularly potassium, calcium, and phosphorus.

  • Discontinuation of triggering drugs: Stop statins or other medications contributing to muscle breakdown.

  • Dialysis: May be necessary if acute kidney injury occurs.

In rare cases, patients may require intensive care or ventilator support, particularly if complications like DIC or compartment syndrome arise.

How to prevent it

While not all cases of rhabdomyolysis are preventable, the risk can be reduced by taking certain precautions, especially for exercise-related cases:

  • Gradually increase exercise intensity to avoid overexertion

  • Stay well-hydrated, especially during physical activity or hot weather

  • Avoid exercise when ill, dehydrated, or taking certain medications

  • Wear appropriate gear for workouts and avoid extreme environments

  • Take rest days to allow muscle recovery

  • Avoid alcohol or recreational drugs, particularly before physical exertion

Early recognition of symptoms during or after intense activity can prevent complications.

Possible complications

Rhabdomyolysis can lead to several severe, sometimes fatal, complications if not treated promptly:

  • Acute kidney injury (AKI): Myoglobin buildup damages the kidneys and may lead to dialysis.

  • Compartment syndrome: Swelling within muscle compartments leads to restricted blood flow, requiring emergency surgery (fasciotomy).

  • Disseminated intravascular coagulation (DIC): Widespread clotting throughout the body, which can lead to organ failure.

  • Cardiac arrhythmias: Electrolyte imbalances can disrupt the heart’s electrical system.

  • Liver dysfunction: In extreme cases, liver enzymes may elevate due to systemic effects.

Preventing these outcomes requires timely intervention.

Long-term outlook

Prognosis depends on how quickly rhabdomyolysis is diagnosed and treated. Most people who receive early care recover fully within days to weeks.

However, outcomes vary:

  • Mild cases resolve with rest and fluids

  • Moderate cases may cause temporary kidney or muscle issues

  • Severe cases, especially with organ damage, may require long-term follow-up

  • Mortality ranges from 8% to 20%, but climbs to 50% in cases involving multiple organ failure

Most kidney function loss is reversible, though a small number of patients develop chronic kidney disease.

When to seek help

Prompt medical attention is critical if you experience any of the following:

  • Sudden, unexplained muscle pain or weakness

  • Urine that is dark or tea-colored

  • Difficulty moving limbs or walking

  • Swelling in muscles

  • Reduced urine output

If you’ve recently engaged in strenuous activity or experienced trauma, especially while taking medications known to affect muscle tissue, don’t wait—contact a healthcare provider immediately.

The bottom line

Rhabdomyolysis is a potentially life-threatening condition caused by the breakdown of skeletal muscle tissue. While it can develop from trauma, infection, medications, or intense physical activity, it is often preventable. Recognizing early symptoms and getting prompt treatment is key to a full recovery. With appropriate care, most individuals return to normal function without lasting effects.