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