Rhabdomyolysis causes

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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

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 InjuryCompartment Syndrome
Immobilizaion
 
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

Disorders of glycolysis

Disorders of lipid metabolism

Disorders of purine metabolism

Other defects

  • 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

References

  1. Clarkson P, Kearns A, Rouzier P, Rubin R, Thompson P (2006). "Serum creatine kinase levels and renal function measures in exertional muscle damage". Med Sci Sports Exerc. 38 (4): 623–7. PMID 16679975.
  2. Larbi EB (1998). "Drug-induced rhabdomyolysis". Annals of Saudi medicine. 18 (6): 525–30. PMID 17344731.
  3. Chabria SB (2006). "Rhabdomyolysis: a manifestation of cyclobenzaprine toxicity". Journal of occupational medicine and toxicology (London, England). 1: 16. doi:10.1186/1745-6673-1-16. PMID 16846511.

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