What Every Personal Trainer Needs to Know About Rhabdomyolysis
Rhabdomyolysis is the breakdown of muscle tissues, which results in the release of its components into the blood. Myoglobin is the major component of muscle, which is released in the bloodstream. An increase in myoglobin in the blood can result in kidney damage or failure. In kidney failure, you are unable to excrete waste products out of the body through urine. Urine becomes dilute because of the absence of solutes and waste products.
However, in patients with rhabdomyolysis without kidney failure, urine is concentrated and dark-colored. In a few cases, rhabdomyolysis can cause death, but urgent medical attention can decrease the risk of death and other complications.
What Causes Rhabdomyolysis?
Rhabdomyolysis occurs as a result of muscle injury that may be traumatic or non-traumatic. Traumatic causes include the following:
- Road traffic accidents, fall from a building, and other crush injuries
- Heatstroke, thermal injuries, and lightning strike
- Lying on a hard surface for a prolonged period during a disease or muscle compression caused by tight plaster after a fracture
- Snake, scorpion, or other insect bites
- Extreme and prolonged physical activity such as marathon
Non-traumatic causes include the following:
- Alcoholism and other addictive substances, including cocaine, amphetamines, and heroin
- Seizures or epilepsy
- Metabolic disorders such as diabetic ketoacidosis and hypothyroidism
- Abnormal fat, carbs, or protein metabolism
- Bacterial infections such as Francisella tularensis, Streptococcus pneumoniae, Group B beta-hemolytic streptococci, Streptococcus pyogenes, and Staphylococcus epidermidis
- Viral infections such as influenza virus, human immunodeficiency virus (HIV), Epstein-Barr virus (EBV), varicella virus, cytomegalovirus (CMV), and herpes simplex virus (HSV)
- Genetic disorders such as Duchenne muscular dystrophy, McArdle’s disease, congenital muscle enzyme deficiencies
- Medications such as erythromycin, cyclosporine, and cholesterol-lowering medications i.e., statins
How is Rhabdomyolysis Diagnosed?
Diagnosis of rhabdomyolysis is made on the basis of clinical assessment (i.e., signs and symptoms) and laboratory investigations.
Signs and symptoms of rhabdomyolysis are confusing, and it is difficult to make an exact diagnosis. It is because the signs and symptoms of rhabdomyolysis may differ according to the cause. In some patients, the disease involves the whole body, while in others, it involves only a part of the body. The timings of complications also differ among patients. In some patients, complications occur early in the disease course, while in others, complications present late in the disease course.
In most patients; rhabdomyolysis presents with a classic triad of symptoms, including the following:
- Muscle weakness or decrease movement of arm and legs
- Muscle pain in lower back, thighs, and shoulders
- Dark-colored urine
Other signs and symptoms include abdominal pain, fever, palpitations, dehydration, altered consciousness, vomiting, nausea, and confusion.
Laboratory investigations in rhabdomyolysis include the following:
- Muscle enzyme levels in the blood are elevated. These enzymes include creatine kinase and lactate dehydrogenase. Creatine kinase is the most sensitive and specific enzyme, which is found in the cardiac muscles, skeletal muscles, and brain.
- Myoglobin levels in blood and urine. It is a breakdown product of muscles and is elevated in rhabdomyolysis.
- Potassium levels are also elevated in the blood because it leaks from muscles and bones. Its levels may be elevated in rhabdomyolysis. Extremely high levels of potassium in the blood may result in severe complications such as kidney failure, cardiac arrest, and abnormal cardiac contractility, and other cardiac functions
- Creatinine is a breakdown end-product of the muscles that is excreted from the body through urine. Its levels may be elevated in rhabdomyolysis.
- Liver function tests that include aspartate aminotransferase (AST) and alanine aminotransferase (ALT) enzyme levels in the blood should also be done. It is due to the fact that about one-fourth of patients with rhabdomyolysis develop liver problems.
How Do You Recover From Rhabdomyolysis?
Recovery in rhabdomyolysis is dependent upon the timing of diagnosis and start of treatment. Early diagnosis and prompt treatment provide significant positive results, and complications can be avoided. However, if the disease is diagnosed late in its course or complications have already occurred, it may require aggressive treatment options like dialysis, and the cure rate is low. Following treatment options are available for rhabdomyolysis and associated complications:
Intravenous and Oral Fluids:
The first step of treatment is aggressive hydration with intravenous fluids containing bicarbonate. Bicarbonate is responsible for excreting the high levels of myoglobin from the body to the outside via kidneys. Oral fluids are also important to maintain electrolyte balance.
A physician usually prescribes medication to maintain your kidney functions. Common medications include diuretics and bicarbonate supplements. Diuretics help in increasing the excretion of waste products and solutes and increase the volume of urine.
Dialysis is reserved for advanced-stage patients with kidney failure. This technique involves cleaning the blood to remove waste products with the help of a dialyzer machine.
Home remedies are effective in mild cases of rhabdomyolysis. These remedies involve bed rest and hydration to help the muscles to recover faster and prevent kidney damage.
Before any program can be created for a new client, it is important to perform an all-encompassing health assessment and physical performance test. These tests can make any underlying risk factors apparent and help a trainer assess the physical capabilities of their new client.
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