Rhabdomyolysis causes

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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.

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

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

• Adenovirus
• Alcoholism
• Alpha-methylacyl-coa racemase (amacr) deficiency
• Anti parkison drug withdrawl
• Antiemetic agents
• Aripiprazole
• Asenapine maleate
• Baclofen withdrawl
• Bacterial pyomyositis
• Barth syndrome
• Brody myopathy (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
• Depolarising neuro-muscular blocker
• Dermatomyositis
• Desflurane
• Diabetic ketoacidosis
• Domperidone
• Droperidol
• E. coli
• Echovirus
• Ehrlichiosis
• Electrical injury
• Electrolyte abnormalities
• Endocrinopathies
• Epstein-barr 
• Falciparum malaria
• Fluphenazine
• GRACILE syndrome
• Haloperidol
• Halothane
• Herpes simplex
• Human immunodeficiency virus
• Hypokalemia
• Hypophosphatemia
• Hypothyroidism
• Iloperidone
• Immobilizaion
• Inflammatory myopathies
• Influenza A and B
• Isoflurane
• Isolated myopathy
• Kearns-Sayre syndrome
• Lactate dehydrogenase deficiency
• L-dopa
• Legionella
• Leigh's disease
• Leptospirosis
• Lipin-1 deficiency
• Long-chain acyl-CoA dehydrogenase deficiency
• Loxapine
• Malignant hyperthermia
• Malignant hyperthermia susceptibility caused by ryr1 gene mutations
• Metabolic myopathies
• Metoclopramide
• Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS)
• Mitochondrial myopathies
• Mycoplasma pneumoniae
• Myoadenylate deaminase deficiency
• Myoclonic epilepsy with ragged red fibers (MERRF)
• Myophosphorylase deficiency
• Neuroleptic malignant syndrome
• Neuroleptics
• Non-ketotic hyperglycemia
• Olanzapine
• Paliperidone
• Parainfluenza
• Perphenazine
• Phosphofructokinase deficiency
• Phosphoglycerate kinase deficiency
• Phosphoglycerate mutase deficiency
• Phosphorylase kinase deficiency
• Polymyositis
• Post - operative surgical trauma
• Post ictal state
• Prochlorperazine
• Promethazine
• Quetiapine
• Risperidone
• Salmonella
• 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 anesthetic agent
• Ziprasidone