Rhabdomyolysis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Approach to the Evaluation of Rhabdomyolysis

• Minimum Evaluation

  • Etiology certain:

    • CBC (complete blood count)
    • CK
    • Chemistries
    • Liver function tests
    • Urine pH

  • Consider looking for hypothyroidism and sickle cell trait.

• Extensive Evaluation:

  • If etiology is uncertain, can check:

    • Thyroid stimulating hormone
    • Erythrocyte glycolytic enzymes
    • CPT I/II in leukocytes
    • Serum carnitine
    • Organic acids in urine.

History and Symptoms

In general, the diagnosis is made when an abnormal renal function and elevated CPK are observed in a patient. To distinguish the causes, a careful medication history is considered useful. Testing for myoglobin levels in blood and urine is rarely performed due to its cost, but may be useful.

Often the diagnosis is suspected when a urine dipstick test is positive for blood, but no cells are seen on microscopic analysis. This suggests myoglobinuria, and usually prompts a measurement of the serum CPK, which confirms the diagnosis.

Symptoms include:

• Constitutional symptoms
• Muscle swelling stiffness, weakness of especially postural muscles (Only 50% will have primary muscular complaints)
• Decreased urine output and red urine
• Familial cases tend to be recurrent and can be precipitated by multiple factors (see below). Ask if symptoms are related to fasting or exercise. Symptoms can be prominent during first 10 minutes of exercise then get better with rest. (Second wind phenomenon).
• Anesthesia induced muscle problems: (myopathy, tetany)