Manifestations:
(1) red colored serum and urine from release of myoglobin
(2) marked elevation of serum creatine kinase (CK)
(3) renal failure in severe cases
(4) muscle weakness, especially in large muscle groups
(5) muscle pain
Biopsy may show:
(1) sickling of red blood cells in blood vessels to affected muscles
(2) necrotizing myositis with or without extensive myonecrosis
A patient with extensive myonecrosis may have a prolonged illness and may require surgery to debride necrotic muscle.
Risk factors may include:
(1) sickle cell disease (vs sickle cell trait)
(2) skeletal muscle hypertrophy associated with exercise
(3) hypoxia
(4) hot weather or hyperthermia
(5) medications, including anabolic steroids
(6) concurrent trauma
(7) dehydration
(8) concurrent infection
(9) seizure disorder
Hemoglobin electropheresis should be included as part of the workup of a patient with unexplained or recurrent rhabdomyolysis.
