Rhabdomyolysis causes

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

Overview

Injuries leading to rhabdomyolysis can be due to mechanical, physical, and chemical causes.

Causes

Mechanical Causes	Physical causes	Chemical causes
Burns Choreoathetosis Compartment syndrome Compression by a tourniquet left for too long Crush injury Excessive exertion Intractable convulsions Local muscle compression due to comatose states Rigidity due to neuroleptic malignant syndrome Surgery	Electric current Extreme physical exertion (although most heavy exercise does not cause kidney damage) High fever or hyperthermia	Alcohol 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. Certain mushrooms like Tricholoma equestre Electrolyte abnormalities Endocrinopathy First-generation H1-receptor antagonists (e.g., diphenhydramine) Heritable muscle enzyme deficiencies Metabolic disorders, Skeletal muscle relaxants that are consumed in overdose are rarely associated with this condition. Statin Various animal toxins Theophylline

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 ❑Immbilizaion

❑Exertional Heat Stroke ❑Sickle Cell Trait ❑Hyperkinetic States Such as *Grand-mal Seizures *Delirium Tremens *Psychotic agitation *Amphetamine Overdose

❑Drugs and toxins ❑Infections ❑Electrolyte abnormalities ❑Endocrinopathies ❑Inflammatory myopathies ❑Miscellaneous

Metabolic myopathies

Mitochondrial myopathies

Malignant hyperthermia

Neuroleptic malignant syndrome

Metabolic myopathies	Mitochondrial myopathies	Malignant hyperthermia	Neuroleptic malignant syndrome
Disorders of glycogenolysis Myophosphorylase deficiency (McArdle disease) 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-CoA 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 (CPEO) Kearns-Sayre syndrome Severe encephalomyopathy of infancy or childhood Barth syndrome GRACILE syndrome Leigh syndrome (subacute necrotizing encephalomyelopathy) Mitochondrial encephalomyopathy with 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 Metoclopromide Prochlorperazine Promethazine Anti Parkison drug withdrawl L-Dopa Bromocriptine Cabergoline

Drugs and toxins	Infections	Electrolyte abnormalities	Endocrinopathies	Inflammatory myopathies	Miscellaneous
DRUGS CAUSING DIRECT MYOTOXICITY Alcohol Amphetamines Antihistamines Antimalarial drugs 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 Tumor necrosis factor inhibitors Toxins Carbon monoxide Mushroom poison Snake venom	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	Hypokalemia Hypophosphatemia	Hypothyroidism Diabetic ketoacidosis Non-ketotic hyperglycemia	Dermatomyositis Polymyositis	Alcoholism Baclofen withdrawl Capillary leak syndrome Status asthmaticus

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Acetaminophen and Oxycodone, Cytarabine, Diphenhydramine, Entacapone, Felbamate, Iodixanol, Ioxilan, Isotretinoin, lamivudine, Sorafenib, Sulfasalazine, Trospium, trientine
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes