Causes of Rhabdomyolysis

The cause of rhabdomyolysis is usually easily identified from the clinical history. There are many causes that fall into four main groups:

1. Medications and Toxic Substances

Direct myotoxicity

The following drugs and toxins cause direct myotoxicity, and increase the risk of rhabdomyolysis.

• HMG CoA reductase inhibitors, i.e. statins
• Statins
• Cyclosporin
• Erythromycin
• Itraconazole
• Colchicine
• Zidovudine
• Corticsteroids

Indirect muscle damage

Indirect muscle damage is caused by drugs and toxins such as:

• Alcohol
• CNS depressants
• Cocaine
• Amphetamines
• LSD
• Ecstasy
• Neuromuscular blockers

2. Trauma, Temperature, Ischaemic and Exertional Causes

Trauma

Traumatic causes include:

• Immobilisation, e.g. following a fall or prolonged period of unconsciousness
• Crush injury
• Extensive Burns
• Lightning injury
• Electric shock

Heat related

Heat related causes of rhabdomyolysis relate to extremes of temperature and include:

• Heatstroke
• Malignant hyperthermia
• Neuroleptic malignant syndrome

Ischaemic causes (Ischaemic limb injury)

Exertional related

Exertional related causes include:

• Marathon running
• Exertion of those untrained and unfit, e.g. participants of a fun run and military recruits
• Pathological muscle exertion
• Physical overexertion in Sickle Cell Disease

3. Infectious Inflammatory Metabolic Causes

Infectious causes

Amongst the infections that cause rhabdomyolysis are:

• Influenza
• HIV
• CMV
• EBV
• HSV
• Streptococcus
• Salmonella
• Legionella
• Staphylococcus

Inflammatory causes

Inflammatory causes of rhabdomyolysis include:

• Polymyositis
• Dermatomyositis

Metabolic disorders

Metabolic disorders that can lead to rhabdomyolysis incldue:

• Hyponatraemia
• Hypernatraemia
• Hypokalaemia
• Hypophosphataemia
• Thyroid storm
• DKA
• HHS

4. Genetic Causes

Genetic Causes

There are also genetic causes of rhabdomyolysis such as:

• Duchenne muscular dystrophy
• Lactate dehydrogenase deficiency
• Myophosphorylase deficiency
• Phosphorylase kinase deficiency
• Phosphofructokinase deficiency
• Carnitine deficiency