Clinical Manifestations of Rhabdomyolysis

Dec 09, 2021 Source: Cainiu Health

Dr. Liu Wan

Introduction

Muscle involvement may manifest as myalgia, muscle tenderness, swelling, and weakness. Systemic inflammatory responses—including fever, generalized fatigue, and elevated white blood cell count and/or neutrophil percentage—may also occur. Urine appearance is typically tea-colored or red-wine colored. Approximately 30% of patients develop acute kidney injury; in severe cases, manifestations of acute kidney injury include oliguria or anuria, along with other signs of azotemia.

Rhabdomyolysis is a very serious condition that can even impair a patient’s quality of life. Therefore, when engaging in fitness activities, it is essential to do so under the guidance of qualified professionals—never attempt exercises blindly on your own, as this may cause bodily injury and lead to severe consequences. The specific details are as follows:

What Are the Clinical Manifestations of Rhabdomyolysis?

Clinical Manifestations

Symptoms include muscle pain, tenderness, swelling, and weakness—indicative of skeletal muscle involvement. Systemic inflammatory responses may also occur, such as fever, generalized fatigue, and elevated white blood cell count and/or neutrophil percentage. Urine appearance is typically tea-colored or resembles red wine due to myoglobinuria. Approximately 30% of rhabdomyolysis cases progress to acute kidney injury (AKI); in severe AKI, manifestations may include oliguria or anuria, along with other signs of azotemia.

Diagnostic Tests

1. Blood Tests

Biochemical assays reveal elevated serum muscle enzymes—including creatine kinase (CK), transaminases, aldolase, and lactate dehydrogenase (LDH)—as well as increased creatinine, blood urea nitrogen (BUN), and uric acid levels. Electrolyte abnormalities such as hyperkalemia and hyperphosphatemia, and metabolic acidosis may be present. Hematologic abnormalities—including thrombocytopenia and disseminated intravascular coagulation (DIC)—may also occur. Myoglobinemia is commonly observed.

2. Urinalysis

Myoglobinuria is characteristic. Urinalysis often shows proteinuria; urine sediment may reveal no red blood cells or only a few, along with granular casts. Urinary myoglobin levels are elevated, and urinary dicarboxylic acid excretion may increase.

3. Muscular Imaging and Electrophysiology

(1) Bone scintigraphy using ^99mTc-MDP demonstrates increased radiotracer uptake in affected muscles.
(2) MRI reveals muscle swelling with high signal intensity on both T1- and T2-weighted images in involved muscles.
(3) Electromyography (EMG) shows myopathic changes at affected sites.

4. Electrocardiogram (ECG)

ECG is performed primarily to assess myocardial effects of hyperkalemia.

To prevent rhabdomyolysis, it is imperative to perform appropriate warm-up exercises before initiating any physical fitness activity. During healthy exercise, avoid arbitrarily increasing resistance or intensity beyond your personal capacity—excessive physical exertion may precipitate rhabdomyolysis. Appropriate, moderate exercise promotes health benefits. We hope the above information is helpful to you, and wish you a happy and healthy life!

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