What Is Rhabdomyolysis?

Definition of rhabdomyolysis

Rhabdomyolysis is a serious medical condition that can be life-threatening if not detected and treated early. It is a complex medical condition which occurs when there is necrosis or damage to the muscle tissue, following which it releases a protein (called myoglobin) and electrolytes into the blood circulation and ultimately, urine, potentially causing complications such as damage to the heart and kidneys. Myoglobin and creatine kinase are the two measurable important components in clinical practice for diagnosing rhabdomyolysis, along with monitoring kidney profiles and cardiac markers.

Recognising signs and symptoms of rhabdomyolysis is essential as it could prompt early treatment and management, thereby reducing the likelihood of  complications of rhabdomyolysis, which can cause death. It has also become vital to create awareness of specific activities which could induce rhabdomyolysis. 

Causes of rhabdomyolysis

  • Muscle trauma and injuries are a primary cause of rhabdomyolysis. Severe muscle injuries, such as in cases of crush injuries or severe muscle compression caused by motor vehicle accidents, could lead to rhabdomyolysis.1
  • Exercise-induced rhabdomyolysis: Intense and prolonged physical activity, especially where the person is not accustomed to the exercise, and training without a proper warm-up, could cause muscle breakdown and lead to rhabdomyolysis. This is often seen in athletes or military personnel during intense exercise.1,12
  • Genetic disorders: such as McArdle’s disease or carnitine palmitoyl-transferase deficiency (CPT deficiency is a  metabolic disorder causing symptoms like painful muscle cramps, weakness and muscular fatigue, and results in rhabdomyolysis during physical activities.2
  • Drugs and substance abuse: Alcohol and substance abuse, in the case of heroin and amphetamine toxicity, can cause rhabdomyolysis. Certain medications or drugs, such as simvastatin,4,5 potentially cause rhabdomyolysis when combined with other medicines. Taking antipsychotics like amitriptyline, haloperidol, and fluoxetine is also a risk factor for rhabdomyolysis.1,3
  • Infections: Viral or bacterial infections are common precipitants for rhabdomylosis. Several cases reported that rhabdomyolysis is a potential late complication of COVID-19 infection.6,7

Symptoms of rhabdomyolysis

Clinically, a person with rhabdomyolysis typically presents with this triad of symptoms: 

  • Unexpected, unbearable, severe muscle cramps and pains over the shoulder, calves and lower back.
  • Muscle fatigue and weakness with difficulty in moving upper and lower extremities.
  • Dark urine (tea or cola-coloured) with reduced urination.

However, some individuals might not have muscle-related symptoms of rhabdomyolysis.9 Instead, rhabdomyolysis may be diagnosed while diagnosing other health issues or during hospitalisations.

Diagnosis and signs of rhabdomyolysis

  • Patient history plays a vital role in diagnosing rhabdomyolysis. In a traumatic accident, a physician usually anticipates the elevation of specific blood components due to muscle damage. It is also wise to ask the affected individual if a family history of the same symptoms occurred prior to the accident, or if there is a history of taking any medications or drugs.
  • Physical examinations in rhabdomyolysis may reveal muscle tenderness with tension and sometimes swelling. General manifestations of rhabdomyolysis may be fever, tachycardia, malaise, nausea, vomiting and abdominal pain.
  • In rhabdomyolysis, blood tests for creatinine kinase and lactate dehydrogenase will be elevated, indicating muscle breakdown.
  • A urine dipstick is used in clinical settings to detect myoglobin or protein in the urine. Myoglobin is also responsible for dark-coloured urine.
  • It is also useful to monitor liver markers such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), as they could be elevated in cases of liver involvement secondary to rhabdomyolysis. It is one of the complications of rhabdomyolysis.
  • To avoid further complications of rhabdomyolysis, such as acute kidney injury that potentially leads to kidney failure, it is best to monitor kidney markers such as blood tests for serum creatinine and blood urea nitrogen (BUN). Electrolyte levels of potassium, calcium and phosphate are also commonly monitored closely in case of rhabdomyolysis.
  • In some instances, like recurrent episodes of rhabdomyolysis with extremely high CK, and persistently high CK levels more than eight weeks after the event, healthcare providers could advise a muscle biopsy to assess the musculoskeletal system for abnormalities10

Treatment and management of rhabdomyolysis

Individuals with rhabdomyolysis need to be monitored closely in an inpatient setting. Fluid replacement and electrolyte correction should be initiated immediately, regardless of renal function, to prevent severe metabolic acidosis and acute kidney injury. The intravenous fluid administered helps to maintain high urine output, which in turn helps flush out myoglobin and avoid kidney damage. Therefore, adequate hydration is vital in rhabdomyolysis.

In the hospital setting, it is essential to assess regularly the kidney function, liver markers and electrolytes to detect and address any signs of kidney damage or liver damage and electrolyte imbalances. 

Addressing underlying issues that cause rhabdomyolysis, such as those caused by medications and toxicity, is also important for the recovery of the individuals. Those medications should be discontinued, and if rhabdomyolysis occurs due to infections, appropriate antibiotics or antivirals should be initiated, considering the drug-to-drug combinations, interactions and toxicity.

The occurrence of rhabdomyolysis can be painful to individuals. Therefore, adequate pain management and bed rest, as well as immobilisation and limiting movement, should be practised on the road to recovery. 


Is rhabdomyolysis treatable?

Yes, with early detection and diagnosis of rhabdomyolysis, it is possible for effective management and treatment to be initiated. Therefore, it is important that the general public understands rhabdomyolysis. Treatment involves intravenous fluid and antibiotics or antiviral administrations, monitoring liver and kidney profiles and electrolytes, and managing complications.

Can rhabdomyolysis be prevented?

Rhabdomyolysis can be prevented by staying hydrated during intense physical exercise. It is also crucial to start any physical activities with a good warm-up and gradually increasing exercise intensity. Awareness of the type of medications, their toxicity and side effects is also a good start in preventing rhabdomyolysis.

Can rhabdomyolysis recur?

Recurrence of rhabdomyolysis is possible, mainly if the underlying conditions causing rhabdomyolysis are not addressed. For individuals with a history of rhabdomyolysis, it is advisable to do a regular medical check-up to monitor rhabdomyolysis markers. 

How many weeks does it take to recover from rhabdomyolysis?

Recovery from rhabdomyolysis can vary among individuals depending on the severity of the condition, how soon the treatment was initiated and individual factors. Sometimes, it can take weeks before someone can fully regain their strength. There is a high possibility of full recovery with early intervention and appropriate treatment. hysiotheraphy and gradual physical exercise may be necessary for fullrecovery. Once a healthcare provider gives an all-clear to be able to start exercising again, then you will be able to do so, as long as you do not push too hard; avoid overworking yourself and always listen to your body's capacities. 

Does rhabdomyolysis cause kidney failure?

Rhabdomyolysis can lead to kidney damage or acute kidney injury (AKI). The myoglobin or proteins released from damaged muscle can clog the kidneys and cause acute kidney injury. AKI can be treated with proper hydration and urine output monitoring. However, late interventions and inadequate treatment or hydration can worsen acute kidney injury conditions and lead to severe damage to kidneys or kidney failure. 

What are the complications of rhabdomyolysis?

What not to do with rhabdomyolysis?

If you have rhabdomyolysis, it is helpful to avoid using anti-inflammatory medications such as ibuprofen, naproxen and aspirin for pain management, as these medications could worsen kidney functions. It is also advisable not to take alcohol during these periods because alcohol could make you more dehydrated, which is not helpful in the process of recovery and could impair more of your kidney’s function.


Rhabdomyolysis is a condition that arises from the rapid breakdown of skeletal muscle tissue which can become a life-threatening condition. The most significant marker in diagnosing rhabdomyolysis is the detection of myoglobin and creatine kinase in urine and blood tests. 

Recognising the symptoms of rhabdomyolysis is critical, and it is essential for treatment to commence early to avoid complications, as it may be fatal. Therefore, it is vital to create awareness in those engaged in activities that are prone to induce rhabdomyolysis, so that they may recognise the signs and  seek medical intervention in a timely manner. 

Individuals who are at risk for rhabdomyolysis include athletes, those with genetic disorders, those with a history of drug or substance abuse, as well as individuals who are involved in an accident or unfortunate situation that puts harm, stress and damage on their musculoskeletal systems. Rhabdomyolysis may also occur in those with an ongoing infection, including those infected with COVID-19.8

The triad of symptoms of rhabdomyolysis are muscular pain and weakness with dark-coloured urine. Diagnosing rhabdomyolysis involves assessing clinical history, physical examinations and specific blood and urine tests. Elevation of creatine kinase and lactate dehydrogenase on blood tests indicates muscle breakdown, and myoglobin in urine indicates leakage occurring in the kidneys due to impaired kidney function.

Treatment of rhabdomyolysis emphasises fluid replacement or hydration with intravenous fluids and simultaneous correction of electrolytes. It is crucial to monitor kidney, liver, electrolytes, cardiac markers, blood gases and urine output and content in clinical settings. It is also essential to address any underlying cause, by discontinuing medications or treating infections if necessary.


  1. Torres PA, Helmstetter JA, Kaye AM, Kaye AD. Rhabdomyolysis: pathogenesis, diagnosis, and treatment. Ochsner J [Internet]. 2015 [cited 2023 Oct 27];15(1):58–69. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365849/
  2. Scalco RS, Gardiner AR, Pitceathly RD, Zanoteli E, Becker J, Holton JL, et al. Rhabdomyolysis: a genetic perspective. Orphanet J Rare Dis [Internet]. 2015 Dec [cited 2023 Oct 27];10(1):51. Available from: http://www.ojrd.com/content/10/1/51
  3. Larbi EB. Drug-induced rhabdomyolysis. Ann Saudi Med [Internet]. 1998 Nov [cited 2023 Oct 27];18(6):525–30. Available from: http://www.annsaudimed.net/doi/10.5144/0256-4947.1998.525
  4. Safitri N, Alaina MF, Pitaloka DAE, Abdulah R. A narrative review of statin-induced rhabdomyolysis: molecular mechanism, risk factors, and management. Drug, Healthcare and Patient Safety [Internet]. 2021 [cited 2023 Oct 27];13:211. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8593596/
  5. Mendes P, Robles PG, Mathur S. Statin-induced rhabdomyolysis: a comprehensive review of case reports. Physiother Can [Internet]. 2014 [cited 2023 Oct 27];66(2):124–32. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006404/
  6. Alrubaye R, Choudhury H. Severe rhabdomyolysis in a 35-year-old woman with COVID-19 due to sars-cov-2 infection: a case report. Am J Case Rep [Internet]. 2020 Jul 17 [cited 2023 Oct 27];21. Available from: https://www.amjcaserep.com/abstract/index/idArt/926733
  7. Jin M, Tong Q. Rhabdomyolysis as a potential late complication associated with COVID-19. Emerg Infect Dis [Internet]. 2020 Jul [cited 2023 Oct 27];26(7):1618–20. Available from: http://wwwnc.cdc.gov/eid/article/26/7/20-0445_article.htm
  8. Valente-Acosta B, Moreno-Sanchez F, Fueyo-Rodriguez O, Palomar-Lever A. Rhabdomyolysis as an initial presentation in a patient diagnosed with COVID-19. BMJ Case Rep [Internet]. 2020 Jun [cited 2023 Oct 29];13(6):e236719. Available from: https://casereports.bmj.com/lookup/doi/10.1136/bcr-2020-236719
  9. Farouji A, Hellou R, Peretz A. Asymptomatic rhabdomyolysis in a young adult with covid-19. Cureus [Internet]. [cited 2023 Oct 27];13(9):e18039. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8523336/
  10. Walters J, Baborie A. Muscle biopsy: what and why and when? Practical Neurology [Internet]. 2020 Oct 1 [cited 2023 Oct 29];20(5):385–95. Available from: https://pn.bmj.com/content/20/5/385
  11. Chatzizisis YS, Misirli G, Hatzitolios AI, Giannoglou GD. The syndrome of rhabdomyolysis: Complications and treatment. European Journal of Internal Medicine [Internet]. 2008 Dec [cited 2023 Oct 29];19(8):568–74. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0953620508000836
  12. Al Badi A, Al Rasbi S, Alalawi AM. Exercise-induced rhabdomyolysis: a case report and literature review. Cureus [Internet]. 2020 Aug 26 [cited 2023 Oct 29]; Available from: https://www.cureus.com/articles/39422-exercise-induced-rhabdomyolysis-a-case-report-and-literature-review
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Nureen Izyani Binti Hashim

Doctor of Medicine, MD (Russia), MSc Public Health, Anglia Ruskin University, Essex

Dr. Izyani Hashim is a Malaysian medical doctor with several years of experience and passion for palliative and primary care and health communications. Having completed her medical degree in Russia and served as a medical doctor in Malaysia, rotating into different fields of medicine, she has gained invaluable experience in clinical care and patient interactions, enabling her to bridge the gap between complex medical information and everyday readers.

She is pursuing a Master’s in Public Health in the United Kingdom. With a mission to empower individuals with reliable health information, Dr. Izyani's articles aim to inspire healthier lives with informed choices. Her articles aim to empower populations with reliable health information, ultimately contributing to improved healthcare and well-being nationwide.

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