Rhabdomyolysis causes: Difference between revisions

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{{Rhabdomyolysis}}
{{Rhabdomyolysis}}
{{CMG}}
{{CMG}}; {{AE}} {{VSKP}}


==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>


==Causes==
==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===
*[[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===
{{familytree/start}}
{{familytree/start}}
Line 13: Line 33:
{{familytree | | | | | C01 | | | | | | | | | C03 |C01=Traumatic or Muscle Compression|C03=Non - Traumatic}}
{{familytree | | | | | C01 | | | | | | | | | C03 |C01=Traumatic or Muscle Compression|C03=Non - Traumatic}}
{{familytree | | | | | |!| | | | | | |,|-|-|-|^|-|-|-|.|}}
{{familytree | | | | | |!| | | | | | |,|-|-|-|^|-|-|-|.|}}
{{familytree | | | | | |!| | | | | | D01 | | | | | | D02 |D01=Non - Traumatic '''Exerional'''|D02=Non - Traumatic '''Non - Exerional'''}}
{{familytree | | | | | |!| | | | | | D01 | | | | | | D02|D01=Non-Traumatic<br>'''Exertional'''|D02=Non-Traumatic<br> '''Non-Exertional'''}}
{{familytree | | | | | |!| | |,|-|-|-|^|-|-|-|.|}}
{{familytree | | | | | |!| | |,|-|-|-|^|-|-|-|.| | | |!|}}
{{familytree | | | | | |!| | E01 | | | | | | E02|E01=Non - Traumatic Exerional Rhadomyolysis in a '''Normal Muscle'''|E02=Non - Traumatic Exerional 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 | | | | | |!| | |!| | | | | | | |!| | | | | | | | | | | | | | |}}
{{familytree | | | | | |!| | |!| | | | | | | |!| | | |!| | | | | | | | | | |}}
{{familytree | | | | | |!| | |`|.| | | | | | |!| | | | | | | | | | | | | | |}}
{{familytree | | | | | |!| | |`|.| | | | | |,|'| | | |!| | | | | | | | | | |}}
{{familytree | | | | | |!| | | |!| | | | | | |!| | | | | | | | | | | | | | |}}
{{familytree | | | | | |!| | | |!| | | | | |!| | | | |!| | | | | | | | | | |}}
{{familytree |boxstyle=text-align: left; | | | | | F01 | | F02 | | | | | |!| | | | | | | | | | | | | | |F01=❑Crush Injury<br> ❑Coma<br> ❑Post Ictal state<br> ❑Post - Operative Surgical trauma<br> ❑Electrical Injury ❑Compartment Syndrome<br> ❑Immbilizaion|F02=❑Exertional<br> ❑Heat Stroke<br> ❑Sickle Cell Trait<br> ❑Hypokalemia<br> ❑Hyperkinetic States Such as<br>*Grand-mal Seizures<br> *Delirium Tremens<br> *Psychotic agitation<br> *Amphetamine Overdose}}
{{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/end}}
{{familytree/end}}


===Mechanical Causes===
{| class="wikitable"
*Burns
! colspan="4" |Non-Traumatic Exertional Rhabdomyolysis in an Abnormal Muscle
*[[Choreoathetosis]]
|-
*[[Compartment syndrome]]
! style="width: 30%;" | '''Metabolic myopathies'''
*Compression by a [[tourniquet]] left for too long
! style="width: 30%;" | '''Mitochondrial myopathies'''
*Crush trauma
! style="width: 20%;" | '''Malignant hyperthermia'''
*Excessive exertion
! style="width: 20%;" | '''Neuroleptic malignant syndrome'''
*[[Seizure|Intractable convulsions]]
|-
*Local muscle compression due to [[coma]]tose states
| valign = top |
*Rigidity due to [[neuroleptic malignant syndrome]]
'''Disorders of glycogenolysis'''
*[[Surgery]]
*[[Glycogen storage disease type V|Myophosphorylase deficiency]]
 
*[[Phosphorylase kinase|Phosphorylase kinase deficiency]]
===Physical causes===
'''Disorders of glycolysis'''
*Electric current
*[[Phosphofructokinase deficiency]]
*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>
*[[Phosphoglycerate kinase|Phosphoglycerate kinase deficiency]]
*High [[fever]] or [[hyperthermia]]
*[[Phosphoglycerate mutase|Phosphoglycerate mutase deficiency]]
 
*[[Lactate dehydrogenase|Lactate dehydrogenase deficiency]]
===Chemical causes===
'''Disorders of lipid metabolism'''
*[[Alcoholic beverage|Alcohol]]
*[[Carnitine palmitoyltransferase deficiency]]
*[[Anoxia]] of the muscle (e.g., [[Bywaters' syndrome]], toxin- and drug-related)
*[[Carnitine deficiency]]
*[[Antibiotics]]
*[[Short-chain acyl-coenzyme A dehydrogenase deficiency]]
*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>
*[[Long-chain acyl-CoA dehydrogenase deficiency]]
*Certain mushrooms like ''[[Tricholoma equestre]]''
*[[LPIN1|Lipin-1 deficiency]]
*Electrolyte abnormalities
'''Disorders of purine metabolism'''
*Endocrinopathy
*[[Myoadenylate deaminase deficiency]]
*First-generation H1-receptor antagonists (e.g., [[diphenhydramine]])
Other defects
*Heritable muscle enzyme deficiencies
*[[Malignant hyperthermia]] susceptibility caused by RYR1 gene mutations
*[[Metabolic disorder]]s,
*[[Alpha-methylacyl-CoA racemase|Alpha-methylacyl-CoA racemase (AMACR) deficiency]]
*Skeletal muscle relaxants 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>
*[[Adenosine triphosphate|Brody myopathy]] ([[Adenosine triphosphate|Calcium adenosine triphosphatase deficiency]])
*[[Statin]]
| valign = top |
*Various animal toxins
*[[Myopathy|Isolated myopathy]]
* [[Theophylline]]
*[[Chronic Progressive External Ophthalmoplegia]]
 
*[[Kearns-Sayre syndrome]]
*[[Mitochondrial myopathy|Severe encephalomyopathy of infancy or childhood]]
*[[Barth syndrome]]
*[[GRACILE syndrome]]
*[[Leigh's disease]]  
*[[Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes]] (MELAS)
*[[Myoclonic epilepsy with ragged red fibers]] (MERRF)
| valign = top |
'''Volatile anesthetic agent'''
*[[Halothane]]
*[[Isoflurane]]
*[[Sevoflurane]]
*[[Desflurane]]
'''Depolarising Neuro-Muscular Blocker'''
*[[Succinylcholine]]
| valign = top |
'''Neuroleptics'''
*[[Aripiprazole]]
*[[Asenapine maleate]]
*[[Chlorpromazine]]
*[[Clozapine]]
*[[Fluphenazine]]
*[[Haloperidol]]
*[[Iloperidone]]
*[[Loxapine]]
*[[Olanzapine]]
*[[Paliperidone]]
*[[Perphenazine]]
*[[Prochlorperazine]]
*[[Quetiapine]]
*[[Risperidone]]
*[[Thioridazine]]
*[[Thiothixene]]
*[[Trifluoperazine]]
*[[Ziprasidone]]
'''Antiemetic agents'''
*[[Domperidone]]
*[[Droperidol]]
*[[Metoclopramide]]
*[[Prochlorperazine]]
*[[Promethazine]]
'''Anti Parkison drug withdrawl'''
*[[L-dopa]]
*[[Bromocriptine]]
*[[Cabergoline]]
|}


===Causes by Organ System===


{|style="width:80%; height:100px" border="1"
{| border="2" cellpadding="5" cellspacing="0" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;" width="75%"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
! colspan="2" |'''Non-Traumatic Non-Exertional Causes'''  
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|{{Center|'''Infections'''}}
|bgcolor="Beige"| No underlying causes
| '''''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]]
|-
|-
|-bgcolor="LightSteelBlue"
|{{Center|'''Electrolyte abnormalities'''}}
| '''Dental'''
| [[Hypokalemia]], [[Hypophosphatemia]]
|bgcolor="Beige"| No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|{{Center|'''Endocrinopathies'''}}
| '''Dermatologic'''
| [[Hypothyroidism]], [[Diabetic ketoacidosis]] , [[Hyperglycemia|Non-ketotic hyperglycemia]]
|bgcolor="Beige"| No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|{{Center|'''Inflammatory myopathies'''}}
| '''Drug Side Effect'''
| [[Dermatomyositis]], [[Polymyositis]]
|bgcolor="Beige"| [[Acetaminophen and Oxycodone]], [[Cytarabine]], [[Diphenhydramine]], [[Entacapone]], [[Felbamate]], [[Iodixanol]], [[Ioxilan]], [[Isotretinoin]], [[lamivudine]], [[Sorafenib]], [[Sulfasalazine]], [[Trospium]], [[trientine]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|-
|{{Center|'''Miscellaneous'''}}
| [[Alcoholism]], [[Baclofen|Baclofen withdrawl]], [[Capillary leak syndrome]], [[Status asthmaticus]]
|}
|}
=== Causes by Alphabetical Order ===
{{columns-list|
*[[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]]
*[[Crush injury]]
*[[Cytomegalovirus]]
*[[Neuromuscular-blocking drugs|Depolarising neuro-muscular blocker]]
*[[Dermatomyositis]]
*[[Desflurane]]
*[[Diabetic ketoacidosis]]
*[[Domperidone]]
*[[Droperidol]]
*[[E. coli]]
*[[Echovirus]]
*[[Ehrlichiosis]]
*[[Electrical injury]]
*[[Electrolyte abnormalities]]
*[[Endocrinology|Endocrinopathies]]
*[[Epstein-Barr|Epstein-barr ]]
*[[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]]
*[[Leigh's disease]]
*[[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]]
*[[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]]
*[[Mitochondrial myopathy|Severe encephalomyopathy of infancy or childhood]]
*[[Sevoflurane]]
*[[Short-chain acyl-coenzyme A dehydrogenase deficiency]]
*[[Staphylococcal infection]]
*[[Status asthmaticus]]
*[[Streptococcus]]
*[[Succinylcholine]]
*[[Thioridazine]]
*[[Thiothixene]]
*[[Trifluoperazine]]
*[[Tularemia]]
*[[Volatile anaesthetic|Volatile anesthetic agent]]
*[[Ziprasidone]]
}}


==References==
==References==

Latest revision as of 22:39, 10 January 2020

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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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