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Rhabdomyolysis Nursing Guide

The contentwas created by Annette Brownlee RN, BSN

Rhabdomyolysis Overview

This content is intended as a Quick Reference for Rhabdomyolysis, where we cover diagnosing, managing, and treatment options for patients with Rhabdomyolysis. 

Rhabdomyolysis Etiology and Epidemiology

Rhabdomyolysis, or rhabdo, occurs when damaged muscle tissue releases substances into the bloodstream and extracellular space. These substances include myoglobin, creatine kinase, aldolase, and lactate dehydrogenase, and electrolytes. The kidneys are responsible for filtering the blood and, in large quantities, these extra substances released by damaged muscles can cause kidney damage. This acute kidney damage can lead to further complications including third spacing caused by excessive tissue breakdown (Stanley et al., 2021).

According to the Centers for Disease Control and Prevention (2019), complications from rhabdomyolysis include compartment syndrome, acute kidney injury, arrhythmia, seizures, nausea and vomiting, disability, and death. About 26,000 people develop rhabdomyolysis each year (Cleveland Clinic, 2019).

Children can develop rhabdomyolysis from traumatic injuries or overheating. Men tend to get rhabdomyolysis more often than women. Older adults can develop rhabdomyolysis from falling and being on the floor for an extended period of time. Some medications can make individuals more prone to rhabdomyolysis as can some genetic conditions.

Common causes of rhabdomyolysis include (Centers for Disease Control and Prevention [CDC], 2019):

  • Injuries from crushing or trauma
  • Injuries from falls, seizures, snake bites, electrical shock, or long-lasting muscle compression
  • Damage caused from over exercising or over training, especially in endurance athletes or athletes who do high intensity interval exercises and are not well conditioned
  • Damage caused by exertion, severe dehydration, or overheating in extremely high temperatures
  • Conditions such as uncontrolled diabetes, muscular dystrophy, and McArdle disease
  • Metabolic or mitochondrial disorders like Krebs cycle disorders
  • Statins, psychiatric agents, antihistamines, and some antibiotics
  • Alcohol, cocaine, and heroin
  • Infections like Epstein-Barr and human immunodeficiency virus

Rhabdomyolysis ICD-10 Code: M62.82

Sourced from ICD10Data.com

Diagnosing Rhabdomyolysis

The diagnosis of rhabdomyolysis is made by a thorough history intake and physical examination by the healthcare provider. Signs and symptoms of rhabdomyolysis include (Torres et al., 2015):

  • Muscle pain, weakness, swelling, and bruising
  • Anuria
  • Tea colored urine
  • Fever
  • Malaise
  • Nausea and vomiting
  • Tachycardia
  • Confusion
  • Agitation

Diagnostic tests that may be ordered include a creatine kinase or creatine phosphokinase level, electrolytes, urinalysis, and a renal panel.

Management

Management and treatment of rhabdomyolysis will depend on the severity of the condition and may include the following treatments:

  • Assess and stabilize airway, breathing, and circulation
  • Administer IV fluids if needed
  • Provide calm environment
  • Initiate fall precautions
  • Initiate seizure precautions
  • Obtain ordered lab work
  • Monitor vital signs
  • Medications as ordered
  • Cardio monitoring, electrocardiograms
  • Temporary dialysis until kidney function returns to baseline

Rhabdomyolysis Nursing Care Plan

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education

for rhabdomyolysis are listed below.

Assessment

Assess signs and symptoms, such as:

  • Vital signs
  • Pain
  • Intake and output
  • Urinary function
  • Increased lethargy
  • Increased weakness
  • Cognitive status
  • Gastrointestinal distress, vomiting, and diarrhea
  • Tachycardia
  • Seizure
  • Psychosocial well-being
  • Edema, swelling, or third spacing

Nursing Diagnosis/Risk For

  • Impaired physical mobility related to myalgia and muscle weakness, evidenced by:
  • Decrease in muscle function
  • Trauma
  • Muscle strength
  • Risk for deficient fluid volume related to reduced blood flow to kidneys, evidenced by:
    • Vomiting
    • Third spacing
    • Inadequate fluid intake
    • Decreased urinary output
  • Risk for shock related to hypovolemia, evidenced by:
    • Slow capillary refill
    • Dysrhythmia
    • Change in level of consciousness
    • Decreased heart rate
    • Hypotension
    • Tachycardia
  • Decreased cardiac output related to elevated potassium levels, evidenced by:
    • Abnormal heart sounds
    • Dyspnea
    • Anxiety, restlessness
    • Change in level of consciousness
    • Decreased cardiac output
    • Dysrhythmias
    • Fatigue
    • Hypotension
    • Tachycardia
    • Decreased peripheral pulses

Interventions

  • Monitor cardiac status.
  • Monitor intake and output.
  • Monitor pain level.
  • Monitor for signs of dehydration.
  • Encourage fluids.
  • Monitor vital signs.
  • Maintain adequate ventilation and oxygenation.
  • Monitor neurological status.
  • Initiate seizure precautions.
  • Initiate fall precautions.
  • Provide psychosocial support to individual and family.
  • Prevent skin breakdown.
  • Administer medications as ordered.
  • Administer intravenous fluids as ordered.
  • Monitor gastrointestinal distress.
  • Monitor labs.

Expected Outcomes

  • Achieves and maintains adequate cardiac output
  • Returns to baseline alertness and orientation
  • Returns to baseline mobility and strength
  • Replenishes fluids
  • Restores kidney function
  • Prevents shock
  • Maintains adequate cardiac output

Individual/Caregiver Education

  • Condition, treatment, and expected outcomes
  • Steps to take to prevent future incidents
  • Side effects of medications
  • Signs and symptoms of rhabdomyolysis
  • Notify healthcare provider or seek immediate medical care for:
    • Tea colored urine
    • Prolonged muscle swelling
    • Fever
    • Tachycardia
    • Anuria
    • Edema
  • Recommended follow-up with healthcare provider

Rhabdomyolysis: Implications for Nursing and PTs

The goal of this course is to inform about the identification, assessment, and management of patients with rhabdomyolysis.

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Additional Information

Content Release Date 

6/11/2024

Content Expiration

12/31/2027

Course Contributor

The content for this course was created by Annette Brownlee RN, BSN

Annette Brownlee is an SME Writer for the Post-Acute Care team. She has a Bachelor of Arts in advertising from Michigan State University and a Bachelor of Science in nursing from the University of Northern Colorado. Annette has worked in skilled nursing and home health. Her most recent experience includes being a Staff Development Coordinator and Infection Preventionist.

References

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