Rhabdomyolysis causes: Difference between revisions

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Latest revision as of 22:39, 10 January 2020

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

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

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 Myophosphorylase deficiency Phosphorylase kinase deficiency Disorders of glycolysis Phosphofructokinase deficiency Phosphoglycerate kinase deficiency Phosphoglycerate mutase deficiency Lactate dehydrogenase deficiency Disorders of lipid metabolism Carnitine palmitoyltransferase deficiency Carnitine deficiency Short-chain acyl-coenzyme A dehydrogenase deficiency Long-chain acyl-CoA dehydrogenase deficiency Lipin-1 deficiency Disorders of purine metabolism Myoadenylate deaminase deficiency Other defects Malignant hyperthermia susceptibility caused by RYR1 gene mutations Alpha-methylacyl-CoA racemase (AMACR) deficiency Brody myopathy (Calcium adenosine triphosphatase deficiency)	Isolated myopathy Chronic Progressive External Ophthalmoplegia Kearns-Sayre syndrome 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)	Volatile anesthetic agent Halothane Isoflurane Sevoflurane Desflurane Depolarising Neuro-Muscular Blocker Succinylcholine	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

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

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

Template:WH Template:WS

[pmid19841484-1] Khan FY (2009) Rhabdomyolysis: a review of the literature. Neth J Med 67 (9):272-83. PMID: 19841484

[1]

@@ Line 4: / Line 4: @@
 ==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==
 ===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===
-{| 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 | | | | | | | | | | B01 | | | | | |B01=Rhadomyolysis}}
@@ Line 68: / Line 39: @@
 {{familytree | | | | | |!| | |`|.| | | | | |,|'| | | |!| | | | | | | | | | |}}
 {{familytree | | | | | |!| | | |!| | | | | |!| | | | |!| | | | | | | | | | |}}
-{{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]] ❑ [[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=❑ [[Metabolic myopathies]]<br> ❑ [[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 |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/end}}
@@ Line 149: / Line 120: @@
 *[[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]]
+*[[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]]
-*[[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]]
+*[[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]]
-| 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==