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INTRODUCTION AND EPIDEMIOLOGY

Rhabdomyolysis is the destruction of skeletal muscle caused by any mechanism that results in injury to myocytes and their membranes. Acute necrosis of skeletal muscle fibers and the leakage of cellular contents into the circulation result in myoglobinuria.

Table 89-1 lists commonly recognized conditions associated with rhabdomyolysis. In general, the most common causes of rhabdomyolysis in adults are drugs of abuse and alcohol, followed by medications, muscle diseases, trauma, neuroleptic malignant syndrome, seizures, immobility, infection, strenuous physical activity, and heat-related illness.1,2 Multiple causes are present in more than half of patients.1 In children, rhabdomyolysis is less common and is more benign.3,4 In a large study of children, the most common causes of nonrecurrent rhabdomyolysis were viral myositis, trauma, and connective tissue disease.4 For adults and children, inherited metabolic disorders should be suspected with recurrent episodes of rhabdomyolysis, especially if associated with exercise intolerance.

TABLE 89-1Common Conditions Associated With Rhabdomyolysis in Adults

Patients in coma are at risk for rhabdomyolysis from unrelieved pressure on gravity-dependent body parts. Alcohol consumption can result in rhabdomyolysis secondary to coma-induced muscle compression and a direct toxic effect. Drugs of abuse and alcohol should be suspected as a primary or contributing cause of rhabdomyolysis in adults. Statin-related myopathies include myalgias with or without elevation of creatine kinase level, muscle weakness, and rhabdomyolysis. Statin-related rhabdomyolysis varies with the particular statin and is dose related. Polypharmacy, including combinations with cyclosporine, macrolide antibiotics, warfarin, digoxin, and dual statin therapy, carries an increased risk for rhabdomyolysis.3,5

A number of bacterial and viral infections including human immunodeficiency virus have been associated with rhabdomyolysis.3,6 Strenuous physical activity, as seen in athletes, marathon runners, military recruits, and outdoor laborers, is a common cause of rhabdomyolysis but ...

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