What is rhabdomyolysis? What causes it? What are the symptoms and how is it treated? Get concise answers to these questions and more in this informative article.

Understanding Rhabdomyolysis

Rhabdomyolysis is a serious condition that occurs when damaged muscle tissue releases its contents into the bloodstream. This can happen due to various causes, including injury, certain medications, genetic disorders, and extreme physical exertion. The release of these muscle components, such as myoglobin, can lead to kidney damage and potentially life-threatening complications.

Causes of Rhabdomyolysis

Rhabdomyolysis can be triggered by a variety of factors, including:

• Trauma or crush injuries: Severe physical trauma, such as a car accident or a fall, can cause muscle damage and the release of muscle contents.
• Certain medications: Drugs like cocaine, amphetamines, statins, and heroin can contribute to the development of rhabdomyolysis.
• Genetic muscle diseases: Conditions that affect the structure or function of muscle fibers can predispose individuals to rhabdomyolysis.
• Extreme temperatures: Both extreme heat and extreme cold can lead to muscle damage and the onset of rhabdomyolysis.
• Ischemia or muscle tissue death: Reduced blood flow to muscles, resulting in oxygen deprivation, can cause muscle breakdown.
• Severe exertion: Prolonged, intense physical activity, such as marathon running or calisthenics, can overwhelm the muscle’s ability to cope with the demands.

Symptoms of Rhabdomyolysis

The primary symptoms of rhabdomyolysis include:

• Dark, red, or cola-colored urine: This discoloration is due to the presence of myoglobin, a protein released from damaged muscle fibers.
• Decreased urine output: The kidneys may have difficulty filtering and excreting the muscle breakdown products.
• General weakness and muscle aches: Patients may experience overall muscle weakness, stiffness, and tenderness.

Other potential symptoms include fatigue, joint pain, seizures, and unintentional weight gain.

Diagnosing Rhabdomyolysis

To diagnose rhabdomyolysis, healthcare providers will typically perform the following tests:

• Creatine kinase (CK) level: Elevated CK levels indicate muscle damage.
• Serum myoglobin: Measuring the levels of this muscle protein in the blood can help confirm the diagnosis.
• Urinalysis: Checking for the presence of myoglobin in the urine is another key diagnostic tool.

Additional tests, such as evaluating serum calcium, potassium, and creatinine levels, may also be performed to assess the extent of the damage and potential complications.

Treating Rhabdomyolysis

The primary treatment for rhabdomyolysis involves the following steps:

1. Fluid resuscitation: Administering intravenous fluids, often containing bicarbonate, to help flush out the muscle breakdown products and prevent kidney damage.
2. Medication management: Healthcare providers may prescribe diuretics and other medications to support kidney function and address any electrolyte imbalances.
3. Dialysis: In severe cases, kidney dialysis may be necessary to filter out the harmful substances and prevent organ failure.

Prompt treatment is crucial, as the earlier rhabdomyolysis is recognized and managed, the better the chances of avoiding long-term complications, such as acute kidney injury.

Preventing Rhabdomyolysis

To reduce the risk of developing rhabdomyolysis, it’s important to:

• Stay hydrated: Drink plenty of fluids, especially after strenuous exercise, to help prevent muscle breakdown.
• Avoid excessive exercise: Gradually increase the intensity and duration of physical activity to allow the muscles to adapt.
• Manage underlying conditions: Individuals with certain genetic or neurological disorders should work closely with their healthcare providers to monitor and manage their condition.
• Be cautious with medications: Consult with a healthcare provider before starting any new medications, especially those that may increase the risk of rhabdomyolysis.

Prognosis and Complications

The prognosis for individuals with rhabdomyolysis largely depends on the severity of the condition and the underlying cause. Prompt treatment can help prevent or minimize the risk of serious complications, such as acute tubular necrosis, acute renal failure, and potentially life-threatening electrolyte imbalances. With proper management, most people with milder cases of rhabdomyolysis are able to recover and return to their normal activities within a few weeks to a month. However, some individuals may continue to experience ongoing issues, such as fatigue and muscle pain.

If you suspect you or someone you know may be experiencing rhabdomyolysis, it’s crucial to seek medical attention immediately. Early recognition and treatment are key to reducing the risk of long-term damage and potentially life-threatening complications.

Rhabdomyolysis: MedlinePlus Medical Encyclopedia

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Rhabdomyolysis is the breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood. These substances are harmful to the kidney and often cause kidney damage.

When muscle is damaged, a protein called myoglobin is released into the bloodstream. It is then filtered out of the body by the kidneys. Myoglobin breaks down into substances that can damage kidney cells.

Rhabdomyolysis may be caused by injury or any other condition that damages skeletal muscle.

Problems that may lead to this disease include:

• Trauma or crush injuries
• Use of drugs such as cocaine, amphetamines, statins, heroin, or PCP
• Genetic muscle diseases
• Extremes of body temperature
• Ischemia or death of muscle tissue
• Low phosphate levels
• Seizures or muscle tremors
• Severe exertion, such as marathon running or calisthenics
• Lengthy surgical procedures
• Severe dehydration

Symptoms may include:

• Dark, red, or cola-colored urine
• Decreased urine output
• General weakness
• Muscle stiffness or aching (myalgia)
• Muscle tenderness
• Weakness of the affected muscles

Other symptoms that may occur with this disease:

• Fatigue
• Joint pain
• Seizures
• Weight gain (unintentional)

A physical exam will show tender or damaged skeletal muscles.

The following tests may be done:

• Creatine kinase (CK) level
• Serum calcium
• Serum myoglobin
• Serum potassium
• Urinalysis
• Urine myoglobin test

This disease may also affect the results of the following tests:

• CK isoenzymes
• Serum creatinine
• Urine creatinine

You will need to get fluids containing bicarbonate to help prevent kidney damage. You may need to get fluids through a vein (IV). Some people may need kidney dialysis.

Your health care provider may prescribe medicines including diuretics and bicarbonate (if there is enough urine output).

Hyperkalemia and low blood calcium levels (hypocalcemia) should be treated right away. Kidney failure should also be treated.

The outcome depends on the amount of kidney damage. Acute kidney failure occurs in many people. Getting treated soon after rhabdomyolysis will reduce the risk of permanent kidney damage.

People with milder cases may return to their normal activities within a few weeks to a month. However, some people continue to have problems with fatigue and muscle pain.

Complications may include:

• Acute tubular necrosis
• Acute renal failure
• Harmful chemical imbalances in the blood
• Shock (low blood pressure)

Contact your provider if you have symptoms of rhabdomyolysis.

Rhabdomyolysis can be avoided by:

• Drinking plenty of fluids after strenuous exercise.
• Removing extra clothes and immersing the body in cold water in case of heat stroke.

• Kidney anatomy

Haseley L, Jefferson JA. Pathophysiology and etiology of acute kidney injury. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 66.

O’Connor FG, Deuster PA. Rhabdomyolysis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier; 2020:chap 105.

Parekh R. Rhabdomyolysis. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 119.

Updated by: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Spasticity – Causes, Symptoms and Treatments

Spasticity is a condition in which muscles stiffen or tighten, preventing normal fluid movement. The muscles remain contracted and resist being stretched, thus affecting movement, speech and gait.

Spasticity is generally caused by damage or disruption to the area of the brain and spinal cord that are responsible for controlling muscle and stretch reflexes. These disruptions can be due to an imbalance in the inhibitory and excitatory signals sent to the muscles, causing them to lock in place. Spasticity can be harmful to growing children as it can affect muscles and joints. People with brain injury, spinal cord injury, cerebral palsy or multiple sclerosis can have varying degrees of spasticity.

Symptoms of spasticity can vary from being mild stiffness or tightening of muscles to painful and uncontrollable spasms. Pain or tightness in joints is also common in spasticity.

• Muscle stiffness, causing movements to be less precise and making certain tasks difficult to perform
• Muscle spasms, causing uncontrollable and often painful muscle contractions
• Involuntary crossing of the legs
• Muscle and joint deformities
• Muscle fatigue
• Inhibition of longitudinal muscle growth
• Inhibition of protein synthesis in muscle cells

   

  Complications

• Urinary tract infections (UTI)
• Chronic constipation
• Fever or other systemic illnesses
• Pressure sores
• Frozen joints

It is important to seek medical care when spasticity is experienced for the first time with no known cause, the spasticity is worsening and becoming more frequent, pain is experienced due to stiff joints and muscles or the condition is preventing performance of everyday tasks. Prolonged and untreated spasticity can lead to frozen joints and/or pressure sores on the skin, which are very painful. Begin by contacting your primary care doctor, who may refer you for further testing or physical therapy.

Due to the varying degrees of spasticity, diagnosis may not be so simple. A physical examination with neurological testing will be done to test for spasticity and the severity of it. Imaging such as magnetic resonance imaging (MRI) can provide more information on the source of spasticity and the extent of the damage that has caused it.

Fortunately, there are several treatment options for spasticity and patients usually undergo more than one treatment at a time. The following treatments have been shown to effectively alleviate symptoms and improve quality of daily life.

• Physical therapy: stretching and strengthening exercises focusing on large muscle groups to improve range of motion and mobility.
• Occupational therapy: exercises that focus on small muscle groups to improve strength and coordination allowing for improved performance of daily tasks. Speech therapy can also be done by patients whose spasticity has affected their speech.
• Casting or bracing: prevents involuntary spasms and reduces tightening of the muscles.
• Oral Medications: oral medications are used in combination with other therapies or medications, such as physical or occupational therapy. Oral medications are only used if symptoms interfere with daily functioning or sleep. Common medications include:
  • Baclofen
  • Benzodiazepines
  • Dantrolene sodium
  • Imidazolines
  • Gabapentin
• Botulinum Toxin (Botox) Injections: Botox injections can be used to paralyze the spastic muscle preventing it from contracting. In small amounts, Botox is injected into carefully selected sites determined based on the pattern of spasticity. Botox injections can last up to 12-16 weeks, but, due to the plasticity of the nervous system, new nerve endings will form and the muscle will no longer be inhibited by the Botox. Additionally, while Botox can be very helpful, there is a limited number of injections that can be administered.

• Intrathecal Baclofen (ITB) Pump: A pump can be surgically placed in a patient’s abdomen and will release a steady dose of baclofen directly to the spinal fluid. This allows for a significant reduction in spasticity and pain with fewer side effects compared to taking baclofen orally. ITB pump therapy should only be considered in extreme cases of spasticity and has been found to be most effective in treating spasticity in the lower and upper extremities.
• Selective Dorsal Rhizotomy (SDR): Spasticity can be caused by an imbalance in electrical signals to antagonist muscles. SDR rebalances the electrical signals sent to the spinal cord by cutting selective nerve roots. This is only done in severe spasticity of the legs. With proper and precise indication of the problematic nerve roots, cutting these roots will decrease muscle stiffness, while maintaining other functions. SDR is most commonly used in patients with cerebral palsy.

Patients are recommended to follow up with their primary care or specialty doctor regularly to ensure proper treatment of the condition. Typically, for surgeries such as baclofen pump placement, patients are followed by their neurosurgeon who sees them three months, six months and 12 months post operatively and additionally for medicine dosing appointments and any device-related appointments. Patients who take oral medications or who do physical and/or occupational therapy should follow-up with their doctors as instructed and needed.

Currently Recruiting:

• Evaluation of a Spasticity Management Program for People With Multiple Sclerosis
• Muscle Selection for Botulinum Toxin A Injection in Poststroke Elbow Flexor Spasticity
• Compare Two Guidance Techniques for Botulinum Toxin Injections for the Treatment of Limb Spasticity and Focal Dystonia
• Comparison of Electrophysiologic and Ultrasound Guidance for Onabotulinum Toxin A Injections in Focal Upper Extremity Dystonia and Spasticity

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Patient Pages are authored by neurosurgical professionals, with the goal of providing useful information to the public.

Julie G Pilitsis, MD, PhD, FAANS

Chair, Neuroscience & Experimental Therapeutics

Professor, Neurosurgery and Neuroscience & Experimental Therapeutics

Albany Medical College

Dr. Pilitsis specializes in neuromodulation with research interests in treatments for movement disorders and chronic pain.

Olga Khazen, BS

Research Coordinator

Neuroscience & Experimental Therapeutics

Albany Medical College

The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information provided is an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon online tool.

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Bioimpedance analysis (bioimpedance) is a method for diagnosing the composition of the human body by measuring the impedance – electrical resistance of body parts – in different parts of the body.

In other words, a weak electric charge is passed through the body, the resistance (impedance) is measured, which gives an idea of ​​the total water content in the body. Since water is contained mainly in the blood, in muscles, nerves, bones, the lean (non-fat) body weight is calculated through the water content, and then, by subtracting from the total body weight, the mass of fat in the body.

Bioimpedancemetry is considered more accurate than body mass index (BMI) because it takes into account not only height and weight, but also the ratio of fat to lean mass. This is the same analysis that can show the difference between fat and “wide bone”.

The main features of bioimpedance analysis include measurements:

• Weight
• Water content
• Bone mass
• Fat mass
• Mass of muscle tissue
• Amount of visceral fat

How is bioimpedancemetry performed?

Before the physical examination, the necessary measurements are taken: height, weight, waist and hips are determined. All measurements, as well as full name, gender and date of birth are entered into the database of the computer program.

During the procedure, the patient should lie on his back, isolated from surrounding electrically conductive objects. There should be no contact between the inner surfaces of the thighs (up to the groin), as well as between the inner surfaces of the arms and the torso (up to the armpits). Watches, chains, rings and bracelets made of metal should be removed from the patient’s hands, and metal objects around the neck should be moved to the chin.

Explanation of the results of bioimpedancemetry

Bioimpedancemetry, in addition to fat and lean mass, determines many more parameters. A doctor will help you not to get confused, who will explain everything, but it would be good to know in advance what questions you will receive answers to.

So what does bioimpedancemetry measure and what do its results mean?

1. The amount of fluid in the body. Determines the volume of intracellular, as well as inter- and extracellular fluid. The indicator of interstitial fluid allows you to find out if there are edema in the body, if fluid is retained. If the amount of interstitial fluid, that is, blood and lymph, is below normal, this indicates a thickening of the blood or that you are not drinking enough. The normal amount of fluid in the body is 45-60% body weight.

2. Body mass index. The famous BMI, which people who are concerned about losing weight know for sure, can be determined in many ways, and bioimpedancemetry is one of them. BMI is the degree to which body weight matches height. Normal weight is considered with a BMI value of 18.50-24.99. Below is underweight, above is overweight. Obesity begins with a BMI of 30.

3. Basal metabolic rate . It is also: basic metabolism, basal metabolism. This is the number of calories that the body burns at rest per day. These calories are necessary for life, and the body will “eat” them in any case, whether you are physically active or not. For everyone, this number is individual, the higher it is, the faster you spend energy; the lower it is, the more likely it is to gain excess weight even with proper nutrition.

4. Active cell mass , or AKM. This is the mass of internal organs, bones, muscles, nerve cells in the aggregate (including the fluid in them). Its deficiency can indicate diseases of internal organs, such as the thyroid gland, and general ill health. It is useful to monitor the change in AKM when you lose weight so that weight loss is not due to it, but due to fat. Normally, AKM is 75-85% of of body weight.

5. Muscle mass. It’s simple: this is the total mass of muscles in the body. This indicator is useful for athletes and those involved in strength training to find out if they are effective. If you want to become stronger, this is the parameter that you need to pay attention to. With malnutrition, the wrong diet and lifestyle, instead of fat, a person loses muscle mass (especially since it goes away much easier than fat), while weight decreases, but this is not the weight loss you dreamed of. In a healthy body, muscle mass is 30-40% of the total.

6. Bone mass. Deficiency may indicate osteoporosis and other diseases that lead to an increased risk of fractures. This parameter most often deviates from the norm with an unbalanced diet, and then its regimen should be reviewed. Bone mass is closely related to the content of calcium in the body, and, as you know, it is needed not only for bone strength, but also for the functioning of muscles and the nervous system, blood clotting. Like other values, bone mass depends on weight.

7. Fat mass, i.e., the amount of fat in the body. The very thing for which losing weight undergo bioimpedansometry. It would seem that this is the same number of kilograms that you need to throw off. But not all fat is extra. It is needed for metabolic processes, thermal insulation, as stored energy. The optimal level of fat for women is 20-29.9% , for men – 10-19.9% ​​ of the total weight.

Indications and contraindications for bioimpedancemetry

Who can benefit from bioimpedancemetry?

• people who want to change muscle mass;
• following different diets and wishing to compare their effectiveness;
• suffering from endocrine diseases, diseases of the liver, kidneys, cardiovascular system, that is, diseases that affect weight;
• people who are overweight or underweight before and during treatment to better monitor results;
• for those who want to know their body better so that they can take better care of it.

Bioimpedancemetry is contraindicated:

• pregnant women;
• people with pacemakers (electrical impulses can affect their work).

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You can learn about all DISCOUNTS and PROMOTIONS in the clinic 9IME THERE ARE CONTRAINDICATIONS. CONSULTATION OF SPECIALISTS IS REQUIRED.

“Bloody” steak – what kind of liquid is released from the meat?

It’s time to stop calling your steak “bloody” because the red juice on your steak plate is not what you think it is. This is a fairly common assumption, which is not true. Almost all of the blood is removed from the meat during cooking, so if you’re squeamish about it, don’t.

What juice comes out of a steak?

Even the most undercooked and reddish steaks are actually almost bloodless. Instead, you see a combination of water, which is about 75 percent of meat, and the protein myoglobin found in muscle tissue. Although the name is similar to hemoglobin, myoglobin is not blood – its task is to transport oxygen through the muscles.

Myoglobin looks like blood on a plate because the iron in myoglobin turns red when exposed to oxygen. This is why muscle tissue is red. Most mammals have a lot of myoglobin in their tissues, which is why mammalian meats, including veal, lamb, and pork, are known as “red meat” while meats from animals with low or no myoglobin levels are known as “white meats.”

Younger animals have less muscle tissue and therefore less myoglobin than older animals. For example, bulls tend to be slaughtered at an older age than pigs, so the liquid is dark red in color and more like blood than pork liquid.

Over time, myoglobin may lose its red color due to chemical changes. Therefore, meat that has lain in the refrigerator for several days becomes brownish. However, this does not mean that the meat has gone bad, so it is better to use other methods of checking for freshness.

When it comes time to cook a steak, the myoglobin darkens when exposed to heat and the meat loses moisture. This is why a medium-rare steak looks “bloody” and a well-done steak turns gray.

How do you keep a steak juicy?

Let the steak stand for about five minutes after cooking so that the juices that are forced out by the heat towards the center of the cut are redistributed and absorbed into the meat. Thus, the steak will lose less liquid during the cutting process, and there will be less “blood” on the plate.

Bottom line: If you’ve cooked a steak well just to remove all the blood, then you should try a medium rare steak. On the other hand, if you cooked a rare steak because of the “blood”, it might be time to rethink your choice.

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