Rhabdomyolysis Quiz
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Muscle pain
Muscle pain in the limbs when pressed or squeezed
Have a fever
Leg pain
Fatigued
Weak
Blood in urine
Not seeing your symptoms? No worries!
What is Rhabdomyolysis?
Rhabdomyolysis is caused by the breakdown of muscle fibers, which release their contents into the blood, leading to electrolyte disturbances and kidney failure. If not treated, it can be potentially fatal. Causes include crush injuries to muscles, overexertion, alcohol misuse, and certain medications that can cause spontaneous muscle injury.
Typical Symptoms of Rhabdomyolysis
- Fever
- Taking medication for high cholesterol
- Muscle pain
- Blood in urine
- Pain or discomfort in arms or legs
- Weakness in your arms or legs
- Muscle pain in legs
- Muscle pain in the limbs when pressed or squeezed
Diagnostic Questions for Rhabdomyolysis
Your doctor may ask these questions to check for this disease:
- Do you have a fever?
- Are you taking cholesterol-lowering medications?
- Are you experiencing muscle pain?
- Do you have blood in your urine?
- Are you experiencing any pain or discomfort in your arms or legs?
Treatment of Rhabdomyolysis
Rhabdomyolysis treatment involves fluid support to flush toxins from the body and prevent kidney failure. Muscles typically recover over time. If the kidney stops functioning, temporary dialysis may be needed to remove toxins and maintain a healthy electrolyte balance. Physical therapy can help strengthen muscles after an initial recovery period.
Reviewed By:
Saqib Baig, MD, MS (Pulmonology, Critical Care, Internal Medicine)
Dr. Baig graduated from Army Medical College (NUST) Pakistan in 2007. He did his internal medicine training from Baltimore, Maryland, USA during the years 2009-2013. He joined the internal medicine faculty practice at Medical College of Wisconsin in USA for 2 years before pursuing advanced training. He completed his pulmonary disease and critical care medicine fellowship from Rutgers Robert Wood Johnson Medical School from 2015-2018. | | During his fellowship, Dr. Baig completed his master's in health care services management through Rutgers Business School. He currently serves as the medical director of respiratory therapy and pulmonary function lab and the clinical director of the COPD program at the Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University. He holds the Assistant Professor of Medicine rank at Sidney Kimmel Medical College at Thomas Jefferson University. Dr. Baig's interests lie in respiratory physiology, airways disease, and data science.
Yoshinori Abe, MD (Internal Medicine)
Dr. Abe graduated from The University of Tokyo School of Medicine in 2015. He completed his residency at the Tokyo Metropolitan Health and Longevity Medical Center. He co-founded Ubie, Inc. in May 2017, where he currently serves as CEO & product owner at Ubie. Since December 2019, he has been a member of the Special Committee for Activation of Research in Emergency AI of the Japanese Association for Acute Medicine. | | Dr. Abe has been elected in the 2020 Forbes 30 Under 30 Asia Healthcare & Science category.
Content updated on Mar 31, 2024
Following the Medical Content Editorial Policy
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- My body is hot
- Recurrent fevers
- Gross hematuria
- Periodic fever (>100.4°F / 38°C)
- Pain in legs
- Fever then no fever then fever again
- Leg muscle pain
- Remittent fever of 102.2°F / 39°C
- Extremely high fever of 106.7°F / 41.5°C or higher
- Abdominal pain
- Fever of 100.4°F / 38°C or more for weeks
- Burning sensation in the muscles
- Stomach was uncomfortable, then had a fever
- Pain in the limb
- Stomachache and diarrhea before a fever
See full list
Symptoms Related to Rhabdomyolysis
Diseases Related to Rhabdomyolysis
FAQs
Q.
Is Creatine Safe? The Real Creatine Benefits & Medical Next Steps
A.
Creatine is considered safe for most healthy adults when used at 3 to 5 grams per day, with strong evidence for gains in strength and high intensity performance plus potential benefits for recovery, cognition, and healthy aging. There are several factors to consider; see below to understand more. Research shows no kidney or liver harm in healthy users at standard doses, though mild bloating or water weight can occur, and rhabdomyolysis is usually tied to extreme exertion and dehydration rather than standard-dose creatine; people with kidney or liver disease, diabetes, high blood pressure, a history of rhabdomyolysis, those who are pregnant or breastfeeding, and teens should talk to a clinician, consider baseline labs, stay well hydrated, and stop for red flags like dark urine, severe muscle pain, or unusual fatigue.
References:
* Antonio, J., Candow, D. G., Forbes, S., Gualano, B., Jagim, A. R., Kreider, R. B., Rawson, E. S., Smith-Ryan, A. E., VanDusseldorp, T. A., Willoughby, D. S., & Ziegenfuss, T. N. (2021). International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. *Journal of the International Society of Sports Nutrition*, 18(1), 13. 10.1186/s12970-021-00412-w
* Linhart, C., Kettner, H., Baur, L., Hoerauf, N., Kreutzer, A., Köhler, K., Proske, I., von Hirschhausen, E., & Wirth, R. (2024). Creatine Supplementation and Safety: A Scoping Review. *Nutrients*, 16(5), 652. 10.3390/nu16050652
* Breslow, R. G., & Goldstein, P. D. (2021). Creatine Supplementation for Health and Disease: An Update. *Nutrients*, 13(1), 226. 10.3390/nu13010226
* de Siqueira, K. V. S., de Oliveira, A. L. N., Cysneiros, R. M., dos Santos, J. M., Ratzka, M. P., da Cruz, I. B. M., Gelain, D. P., & da Rocha, J. B. T. (2023). Creatine and the Brain: A Special Emphasis on Creatine Supplementation in Mild Cognitive Impairment and Alzheimer's Disease. *Nutrients*, 15(20), 4410. 10.3390/nu15204410
* Ostojic, S. M., & Korovljev, D. (2022). Long-Term Effects of Creatine Supplements: a Review. *Frontiers in Sports and Active Living*, 4, 1024523. 10.3389/fspor.2022.1024523
Q.
Intense Pressure? Compartment Syndrome: The Medical Reality and Urgent Next Steps
A.
Compartment syndrome is a rare but true emergency in which rising pressure inside a limb compartment chokes off blood flow, causing severe out-of-proportion pain and rapid muscle and nerve injury; acute cases often follow fractures or crush injuries and may require urgent fasciotomy within hours. There are several factors to consider, including how to tell acute from chronic exertional symptoms and when to act; see below for essential signs, timelines, and step-by-step next actions. If you have intense, worsening pain, tight swelling, numbness, or weakness after an injury, go to the ER now, while exercise-linked pain that eases with rest is usually nonemergent but still needs medical guidance; details on risks like rhabdomyolysis, casts, and who is most at risk are outlined below.
References:
* McQueen, M. M., & Court-Brown, C. M. (2011). Compartment syndrome. *Journal of the American Academy of Orthopaedic Surgeons*, *19*(12), 733-742.
* Schmidt, A. H. (2012). Acute compartment syndrome. *The Journal of Bone and Joint Surgery. American Volume*, *94*(11), 1018-1025.
* Olson, S. A., & Rhorer, A. S. (2018). Acute compartment syndrome: a review of the current literature. *Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association*, *23*(4), 559-566.
* Via, A. G., & Gants, S. (2019). Acute compartment syndrome: pathophysiology, diagnosis, and treatment. *Annals of Translational Medicine*, *7*(11), 238.
* Haddock, N. T., & Kayal, P. N. (2021). Diagnosis of acute compartment syndrome of the limb: A narrative review. *Journal of Clinical Orthopaedics and Trauma*, *15*, 102-108.
Q.
Is Creatine Safe? What It Really Does & Medically Approved Next Steps
A.
For most healthy adults, creatine monohydrate is considered safe at recommended doses and helps your muscles rapidly regenerate ATP for short, intense activity, though mild water retention or stomach upset can occur. There are several factors to consider, including avoiding use or seeking medical advice if you have kidney or liver disease, are pregnant or under 18, or take medicines that affect the kidneys, plus choosing 3 to 5 grams daily without loading, staying hydrated, and watching for rare serious symptoms like severe muscle pain with dark urine. For full details and medically approved next steps, see below.
References:
* Antonio, J., Candow, D. G., Forbes, S. C., Gualano, B., Jagim, A. R., Kreider, R. B., Rawson, E. S., Smith-Ryan, A. E., VanDusseldorp, T. A., Willoughby, D. S., & Ziegenfuss, T. N. (2021). Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? *Journal of the International Society of Sports Nutrition*, *18*(1), 13.
* Kreider, R. B., Kalman, D. S., Antonio, J., Ziegenfuss, T. N., Wildman, R., Collins, R., Candow, D. G., Kleiner, S. M., Almada, A. L., & Lopez, H. L. (2017). International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. *Journal of the International Society of Sports Nutrition*, *14*, 18.
* Gualano, B., Rawson, E. S., Candow, D. G., van der Merwe, J., & Roschel, H. (2020). Creatine in Health and Disease. *Nutrients*, *12*(9), 2772.
* Gualano, B., & Roschel, H. (2018). Creatine and Kidney Function: Is This a Concern? *Advances in Nutrition*, *9*(Suppl_1), 47–52.
* Wax, B., Kerksick, C. M., Jagim, A. R., Mayo, J. J., Lyons, B. C., & Kreider, R. B. (2023). Creatine for Exercise and Sports Performance, with a Focus on Gender. *Nutrients*, *15*(7), 1673.
Q.
Is It Rhabdomyolysis? Why Your Muscle is Breaking Down & Urgent Medical Steps
A.
Rhabdomyolysis is a serious, often urgent condition where damaged muscle releases myoglobin and CK, leading to severe muscle pain or weakness and dark, tea-colored urine, with risk of kidney injury and dangerous heart rhythms. If you notice dark urine with muscle pain, swelling, or little urine, seek urgent care for CK and kidney tests and early IV fluids, which usually lead to full recovery when started promptly. There are several factors to consider, including causes like extreme exercise, heat, medications, and dehydration, and how to tell rhabdo from normal soreness; see the complete details below to guide your next steps.
References:
* Chavez LO, Leon M, Einav S. Rhabdomyolysis: Pathophysiology, diagnosis, and treatment. Crit Care. 2021 Jul 15;25(1):210. doi: 10.1186/s13054-021-03632-y.
* Khan FY. Rhabdomyolysis: a review of the literature. World J Emerg Med. 2020;11(1):5-10. doi: 10.5847/wjem.j.1920-8642.2020.01.002.
* Torres PA, et al. Rhabdomyolysis: causes, complications, and management. Ren Fail. 2015 Nov;37(9):1428-36. doi: 10.3109/08860446.2015.1070502.
* Nance JR, Mammen AL. Acute Kidney Injury Due to Rhabdomyolysis: An Update on the Pathophysiology, Diagnosis, and Management. Curr Sports Med Rep. 2015 Jul-Aug;14(4):300-9. doi: 10.1249/JSR.0000000000000171.
* Zutt R, et al. Rhabdomyolysis: A Review. J Clin Neuromusc Dis. 2014 Dec;16(2):64-77. doi: 10.1097/NMD.0000000000000068.
Q.
Is It Safe? The Truth About Creatine Monohydrate & Medical Next Steps
A.
Creatine monohydrate is generally safe for most healthy adults when used as directed, with typical effects like temporary water retention or mild stomach upset, and no proven kidney harm in people with normal kidney function. There are several factors to consider, especially if you have kidney or liver disease, diabetes with kidney involvement, are pregnant, or take medicines that affect the kidneys; smart next steps include reviewing your history, considering baseline labs, using 3 to 5 grams daily, staying hydrated, and seeking urgent care for severe muscle pain or dark urine. See complete details below to guide your decision and medical follow up.
References:
* Gualano, B., Rawson, E. S., Candow, D. G., Chung, W., Smith-Ryan, A. E., & Van Every, D. W. (2023). Creatine in Health and Disease. *Nutrients*, *15*(4), 947. doi:10.3390/nu15040947
* Antonio, J., Candow, D. G., Forbes, S. C., Gualano, B., Jagim, A. R., Kreider, R. B., Rawson, E. S., Smith-Ryan, A. E., Van Every, D. W., & Ziegenfuss, T. N. (2021). Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? *Journal of the International Society of Sports Nutrition*, *18*(1), 13. doi:10.1186/s12970-021-00412-w
* Kreider, R. B., Antonio, J., Butts, J., Candow, D. G., Collins, D., Cooke, M., ... & Ziegenfuss, T. N. (2017). International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. *Journal of the International Society of Sports Nutrition*, *14*(1), 18. doi:10.1186/s12970-017-0173-z
* Forbes, S. C., Candow, D. G., Van Every, D. W., Gualano, B., & Smith-Ryan, A. E. (2021). Creatine Supplementation: An Update. *Journal of the International Society of Sports Nutrition*, *18*(1), 33. doi:10.1186/s12970-021-00438-w
* Park, S. H., Park, J. W., & Kim, C. W. (2023). Creatine and Creatine Forms: A Comprehensive Review on Efficacy, Safety, and Quality. *Journal of Exercise Nutrition & Biochemistry*, *27*(1), 15-32. doi:10.26786/jenb.2023.03.31.002
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1References
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https://www.sciencedirect.com/science/article/abs/pii/S0011502920300778?via%3DihubSzugye HS. Pediatric Rhabdomyolysis. Pediatr Rev. 2020 Jun;41(6):265-275. doi: 10.1542/pir.2018-0300. PMID: 32482689.
https://publications.aap.org/pediatricsinreview/article-abstract/41/6/265/35412/Pediatric-Rhabdomyolysis?redirectedFrom=fulltextBosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury. N Engl J Med. 2009 Jul 2;361(1):62-72. doi: 10.1056/NEJMra0801327. Erratum in: N Engl J Med. 2011 May 19;364(20):1982. PMID: 19571284.
https://www.nejm.org/doi/full/10.1056/NEJMra0801327Zimmerman JL, Shen MC. Rhabdomyolysis. Chest. 2013 Sep;144(3):1058-1065. doi: 10.1378/chest.12-2016. PMID: 24008958.
https://journal.chestnet.org/article/S0012-3692(13)60626-1/fulltextGupta A, Thorson P, Penmatsa KR, Gupta P. Rhabdomyolysis: Revisited. Ulster Med J. 2021 May;90(2):61-69. Epub 2021 Jul 8. PMID: 34276082; PMCID: PMC8278949.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278949/