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


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
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