Issue

Vol. 3 No. 1 (2026)

Date Log

Submitted
November 10, 2026
Published
November 10, 2026

Copyright (c) 2026 Mohammed Owaid Mutlaq Alanazi, Musallam Humaidan Musallam Alanzi, Bassam Alrimthi Alanazi, Mohand Awdah M. Albawe, Sultan Mansour Alanezi, Abdulaziz Khalaf Habib Alanazi, Khalif Hamoud Khalaf Al-Arjan, Salman Ratyan Alhazmi, Mashhour Shaqi Alrruwaili

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Rhabdomyolysis in Emergency Care: Recent Advances in Pathophysiology, Biochemical Diagnosis, and Management-An Updated Review.

https://doi.org/10.64483/202631827
Mohammed Owaid Mutlaq Alanazi
Saudi Red Crescent Authority, Al-Shuqaiq Ambulance Center, Al-Jouf Region, Saudi Arabia
Musallam Humaidan Musallam Alanzi
Saudi Red Crescent Authority, Al-Shuqaiq, Al-Jouf Region, Saudi Arabia
Bassam Alrimthi Alanazi
Saudi Red Crescent Authority, Al-Shuqaiq Ambulance Center, Al-Jouf Region, Saudi Arabia
Mohand Awdah M. Albawe
Saudi Red Crescent Authority, Al-Jouf Region, Saudi Arabia
Sultan Mansour Alanezi
Saudi Red Crescent Authority, Al-Jouf Region, Saudi Arabia
Abdulaziz Khalaf Habib Alanazi
Saudi Red Crescent Authority, Al-Shuqaiq Ambulance Center, Al-Jouf Region, Saudi Arabia
Khalif Hamoud Khalaf Al-Arjan
Saudi Red Crescent Authority, Al-Shuqaiq, Al-Jouf Region, Saudi Arabia
Salman Ratyan Alhazmi
Saudi Red Crescent Authority, Al-Jouf Region, Saudi Arabia
Mashhour Shaqi Alrruwaili
Saudi Red Crescent Authority, Al-Shuqaiq Ambulance Center, Sakaka, Al-Jouf Region, Saudi Arabia

Corresponding Author(s) : Mohammed Owaid Mutlaq Alanazi

mohammedmutlaq@gmail.com

Saudi Journal of Medicine and Public Health, Vol. 3 No. 1 (2026)

Abstract

Background: Rhabdomyolysis (RM) is a clinical syndrome characterized by skeletal muscle damage and the release of intracellular components, including creatine kinase (CK), myoglobin, and electrolytes, into the circulation. It can result from traumatic injuries, excessive physical exertion, medications, infections, and metabolic disorders. Delayed recognition and inadequate management may lead to acute kidney injury (AKI), electrolyte disturbances, compartment syndrome, and multiorgan dysfunction. Advances in diagnostic technologies and artificial intelligence (AI) have created new opportunities to improve early detection and risk assessment.


Aim: This review aims to summarize recent advances in the etiology, pathogenesis, complications, diagnosis, AI-assisted assessment, and treatment of RM, with emphasis on clinical evaluation and strategies to prevent serious complications.


Methods: A narrative review approach was used to discuss relevant evidence concerning the mechanisms of muscle injury, clinical manifestations, diagnostic biomarkers, imaging techniques, predictive models, and current therapeutic approaches.


Results: RM develops through mechanisms involving ATP depletion, intracellular calcium accumulation, oxidative stress, and disruption of muscle cell membranes. CK and myoglobin remain the principal biochemical markers, while imaging and emerging biomarkers may provide additional diagnostic information. AI-based models have demonstrated potential for predicting AKI and mortality, with some studies reporting better performance than conventional severity scores. Early identification of the underlying cause, intravenous fluid resuscitation, electrolyte monitoring, and appropriate management of renal complications remain central to treatment. However, evidence supporting routine use of bicarbonate, mannitol, and diuretics remains insufficient.


Conclusion: Early recognition and individualized management are essential to reduce RM-associated complications and improve patient outcomes.

Keywords

Rhabdomyolysis; Acute kidney injury; Creatine kinase; Myoglobin; Diagnosis; Artificial intelligence; Fluid resuscitation.
Alanazi, M. O. M., Alanzi, M. H. M., Alanazi, B. A., Albawe, M. A. M., Alanezi, S. M., Alanazi, A. K. H., … Alrruwaili, M. S. (2026). Rhabdomyolysis in Emergency Care: Recent Advances in Pathophysiology, Biochemical Diagnosis, and Management-An Updated Review. Saudi Journal of Medicine and Public Health, 3(1), 353–368. https://doi.org/10.64483/202631827
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX
References
  1. 1. Zutt R, van der Kooi AJ, Linthorst GE, et al. Rhabdomyolysis: review of the literature. Neuromuscul Disord. 2014;24:651-659. https://doi.org/10.1016/j.nmd.2014.05.005.
  2. 2. Bosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury. N Engl J Med. 2009;361:62-72. https://doi.org/10.1056/NEJMra0801327.
  3. 3. Rixey AB, Glazebrook KN, Powell GM, et al. Rhabdomyolysis: a review of imaging features across modalities. Skelet Radiol. 2024;53:19-27. https://doi.org/10.1007/s00256-023-04378-5.
  4. 4. Rojas-Valverde D, Sánchez-Ureña B, Crowe J, et al. Exertional rhabdomyolysis and acute kidney injury in endurance sports: a systematic review. Eur J Sport Sci. 2021;21:261-274. https://doi.org/10.1080/17461391.2020.1746837.
  5. 5. Luetmer MT, Boettcher BJ, Franco JM, et al. Exertional rhabdomyolysis: a retrospective population-based study. Med Sci Sports Exerc. 2020;52:608-615. https://doi.org/10.1249/MSS.0000000000002178.
  6. 6. Zimmerman JL, Shen MC. Rhabdomyolysis. Chest. 2013;144:1058-1065. https://doi.org/10.1378/chest.12-2016.
  7. 7. Sharma U. Statin-induced delayed rhabdomyolysis. BMJ Case Rep. 2019;12: e231125. https://doi.org/10.1136/bcr-2019-231125.
  8. 8. Cabral B, Edding SN, Portocarrero JP, et al. Rhabdomyolysis. Dis Mon. 2020;66: 101015. https://doi.org/10.1016/j.disamonth.2020.101015.
  9. 9. Huerta-Alardín AL, Varon J, Marik PE. Bench-to-bedside review: rhabdomyolysis - an overview for clinicians. Crit Care. 2005;9:158-169. https://doi.org/10.1186/cc2978.
  10. 10. Blais A. Succinylcholine, malignant hyperthermia and rhabdomyolysis. CMAJ (Can Med Assoc J). 2022;194:E878. https://doi.org/10.1503/cmaj.146480-l.
  11. 11. Johnston CI, Isbister GK. Australian snakebite myotoxicity (ASP-23). Clin Toxicol. 2021;59:611-618. https://doi.org/10.1080/15563650.2020.1836377.
  12. 12. Chavez LO, Leon M, Einav S, et al. Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. Crit Care. 2016;20:135. https://doi.org/10.1186/s13054-016-1314-5.
  13. 13. Bagley WH, Yang H, Shah KH. Rhabdomyolysis. Intern Emerg Med. 2007;2: 210-218. https://doi.org/10.1007/s11739-007-0060-8.
  14. 14. Baeza-Trinidad R. Rhabdomyolysis: a syndrome to be considered. Med Clin. 2022;158:277-283. https://doi.org/10.1016/j.medcli.2021.09.025.
  15. 15. Zhang MH. Rhabdomyolosis and its pathogenesis. World J Emerg Med. 2012;3: 11-15. https://doi.org/10.5847/wjem.j.issn.1920-8642.2012.01.002.
  16. 16. Gupta A, Thorson P, Penmatsa KR, et al. Rhabdomyolysis: revisited. Ulst Med J. 2021;90:61-69.
  17. 17. Torres PA, Helmstetter JA, Kaye AM, et al. Rhabdomyolysis: pathogenesis, diagnosis, and treatment. Ochsner J. 2015;15:58-69.
  18. 18. Parekh R, Care DA, Tainter CR. Rhabdomyolysis: advances in diagnosis and treatment. Emerg Med Pract. 2012;14:1-15.
  19. 19. Bywaters EG, Beall D. Crush injuries with impairment of renal function. Br Med J. 1941;1:427-432. https://doi.org/10.1136/bmj.1.4185.427.
  20. 20. Lima RSA, da Silva Junior GB, Liborio AB, et al. Acute kidney injury due to rhabdomyolysis. Saudi J of Kidney Dis Transpl. 2008;19:721-729.
  21. 21. Boutaud O, Roberts 2nd LJ. Mechanism-based therapeutic approaches to rhabdomyolysis-induced renal failure. Free Radic Biol Med. 2011;51: 1062-1067. https://doi.org/10.1016/j.freeradbiomed.2010.10.704.
  22. 22. Simpson JP, Taylor A, Sudhan N, et al. Rhabdomyolysis and acute kidney injury: creatine kinase as a prognostic marker and validation of the McMahon Score in a 10-year cohort: a retrospective observational evaluation. Eur J Anaesthesiol. 2016;33:906-912. https://doi.org/10.1097/EJA.0000000000000490.
  23. 23. Gumbert SD, Kork F, Jackson ML, et al. Perioperative acute kidney injury. Anesthesiology. 2020;132:180-204. https://doi.org/10.1097/ALN.0000000000002968.
  24. 24. Kim MJ, Valerio C, Knobloch GK. Potassium disorders: hypokalemia and hyperkalemia. Am Fam Physician. 2023;107:59-70.
  25. 25. Singh D, Chander V, Chopra K. Rhabdomyolysis. Methods Find Exp Clin Pharmacol. 2005;27:39-48. https://doi.org/10.1358/mf.2005.27.1.875435.
  26. 26. Chatzizisis YS, Misirli G, Hatzitolios AI, et al. The syndrome of rhabdomyolysis: complications and treatment. Eur J Intern Med. 2008;19:568-574. https://doi.org/10.1016/j.ejim.2007.06.037.
  27. 27. Lelonge Y, Gavid M, Vieville M, et al. Tension pneumoperitoneum and acute abdominal compartment syndrome during panendoscopy. Eur Ann Otorhinolaryngol Head Neck Dis. 2023;140:99-100. https://doi.org/10.1016/j.anorl.2022.06.006.
  28. 28. Shi W, Wu D, Si N, et al. [The 463rd case: rhabdomyolysis, acute kidney failure and acute hepatic failure]. Zhonghua Nei Ke Za Zhi. 2018;57:381-384. https://doi.org/10.3760/cma.j.issn.0578-1426.2018.05.019.
  29. 29. Melila M, Rajaram R, Ganeshkumar A, et al. Assessment of renal and hepatic dysfunction by co-exposure to toxic metals (Cd, Pb) and fluoride in people living nearby an industrial zone. J Trace Elem Med Biol. 2022;69:126890. https://doi.org/10.1016/j.jtemb.2021.126890.
  30. 30. Zhao YW, Wang DQ, Deng JW, et al. The value of muscle biopsy in rhabdomyolysis. Zhonghua Nei Ke Za Zhi. 2019;58:899-904. https://doi.org/10.3760/cma.j.issn.0578-1426.2019.12.006.
  31. 31. Lippi G, Schena F, Ceriotti F. Diagnostic biomarkers of muscle injury and exertional rhabdomyolysis. Clin Chem Lab Med. 2018;57:175-182. https://doi.org/10.1515/cclm-2018-0656.
  32. 32. Carrillo-Esper R, Galván-Talamantes Y, Meza-Ayala CM, et al. Ultrasound findings in rhabdomyolysis. Cir Cir. 2016;84:518-522. https://doi.org/10.1016/j.circir.2015.06.036.
  33. 33. Nassar A, Talbot R, Grant A, et al. Rapid diagnosis of rhabdomyolysis with point-of-care ultrasound. West J Emerg Med. 2016;17:801-804. https://doi.org/10.5811/westjem.2016.8.31255.
  34. 34. Hans PS, Ahn JS, Kim DJ. Ultrasound features of rhabdomyolysis. CJEM. 2020;22:386-388. https://doi.org/10.1017/cem.2020.16.
  35. 35. Lu CH, Tsang YM, Yu CW, et al. Rhabdomyolysis: magnetic resonance imaging and computed tomography findings. J Comput Assist Tomogr. 2007;31: 368-374. https://doi.org/10.1097/01.rct.0000250115.10457.e9.
  36. 36. Mian AZ, Saito N, Sakai O. Rhabdomyolysis of the head and neck: computed tomography and magnetic resonance imaging findings. Dentomaxillofacial Radiol. 2011;40:390-392. https://doi.org/10.1259/dmfr/52800685.
  37. 37. Sein AŁ, Kosiak W. Sonographic appearance of rhabdomyolysis - a systematic review of the literature. Med Ultrason. 2020;22:92-96. https://doi.org/10.11152/mu-2285.
  38. 38. Moratalla MB, Braun P, Fornas GM. Importance of MRI in the diagnosis and treatment of rhabdomyolysis. Eur J Radiol. 2008;65:311-315. https://doi.org/10.1016/j.ejrad.2007.03.033.
  39. 39. Bäcker HC, Richards JT, Kienzle A, et al. Exertional rhabdomyolysis in athletes: systematic review and current perspectives. Clin J Sport Med. 2023;33: 187-194. https://doi.org/10.1097/JSM.0000000000001082.
  40. 40. Laitselart P, Derely J, Daban JL, et al. Relationship between creatine kinase and liver enzymes in war wounded with rhabdomyolysis. Injury. 2022;53:166-170. https://doi.org/10.1016/j.injury.2021.10.004.
  41. 41. Wu M, Wang C, Zhong L, et al. Serum myoglobin as predictor of acute kidney injury and 90-day mortality in patients with rhabdomyolysis after exertional heatstroke: an over 10-year intensive care survey. Int J Hyperther. 2022;39: 446-454. https://doi.org/10.1080/02656736.2022.2046183.
  42. 42. Tarazona V, Figueiredo S, Hamada S, et al. Admission serum myoglobin and the development of acute kidney injury after major trauma. Ann Intensive Care. 2021;11:140. https://doi.org/10.1186/s13613-021-00924-3.
  43. 43. Moulla Y, Lyros O, Adolf D, et al. A nomogram based on clinical factors to predict the serum myoglobin levels following bariatric surgery. Obes Surg. 2018;28:1697-1703. https://doi.org/10.1007/s11695-017-3078-7.
  44. 44. Kasaoka S, Todani M, Kaneko T, et al. Peak value of blood myoglobin predicts acute renal failure induced by rhabdomyolysis. J Crit Care. 2010;25:601-604. https://doi.org/10.1016/j.jcrc.2010.04.002.
  45. 45. Lippi G, Schena F, Salvagno GL, et al. Acute variation of biochemical markers of muscle damage following a 21-km, half-marathon run. Scand J Clin Lab Invest. 2008;68:667-672. https://doi.org/10.1080/00365510802126844.
  46. 46. Martinez T, Liaud-Laval G, Laitselart P, et al. Study of the relationship between liver function markers and traumatic rhabdomyolysis: a retrospective study of hemorrhagic patients admitted to intensive care unit in a level I trauma center. Anesth Analg. 2023;136:842-851. https://doi.org/10.1213/ANE.0000000000006406.
  47. 47. Chalchat E, Charlot K, Garcia-Vicencio S, et al. Circulating microRNAs after a 24-h ultramarathon run in relation to muscle damage markers in elite athletes. Scand J Med Sci Sports. 2021;31:1782-1795. https://doi.org/10.1111/sms.14000.
  48. 48. Nozaki K, Pestronk A. High aldolase with normal creatine kinase in serum predicts a myopathy with perimysial pathology. J Neurol Neurosurg Psychiatry. 2009;80:904-908. https://doi.org/10.1136/jnnp.2008.161448.
  49. 49. Goldstein RA. Skeletal muscle injury biomarkers: assay qualification efforts and translation to the clinic. Toxicol Pathol. 2017;45:943-951. https://doi.org/10.1177/0192623317738927.
  50. 50. Tonomura Y, Matsushima S, Kashiwagi E, et al. Biomarker panel of cardiac and skeletal muscle troponins, fatty acid binding protein 3 and myosin light chain 3 for the accurate diagnosis of cardiotoxicity and musculoskeletal toxicity in rats. Toxicology. 2012;302:179-189. https://doi.org/10.1016/j.tox.2012.07.012.
  51. 51. Nishita T, Ohohashi T, Asari M. Determination of carbonic anhydrase III isoenzyme concentration in sera of racehorses with exertional rhabdomyolysis. Am J Vet Res. 1995;56:162-166.
  52. 52. Safari S, Yousefifard M, Hashemi B, et al. The value of serum creatine kinase in predicting the risk of rhabdomyolysis-induced acute kidney injury: a systematic review and meta-analysis. Clin Exp Nephrol. 2016;20:153-161. https://doi.org/10.1007/s10157-015-1204-1.
  53. 53. Ostrowski P, Bonczar M, Avram AE, et al. Safety monitoring of drug-induced muscle injury and rhabdomyolysis: a biomarker-guided approach for clinical practice and drug trials. Clin Chem Lab Med. 2023;61:1688-1699. https://doi.org/10.1515/cclm-2023-0313.
  54. 54. Premru V, Kovač J, Ponikvar R. Use of myoglobin as a marker and predictor in myoglobinuric acute kidney injury. Ther Apher Dial. 2013;17:391-395. https://doi.org/10.1111/1744-9987.12084.
  55. 55. Raju NA, Rao SV, Joel JC, et al. Predictive value of serum myoglobin and creatine phosphokinase for development of acute kidney injury in traumatic rhabdomyolysis. Indian J Crit Care Med. 2017;21:852-856. https://doi.org/10.4103/ijccm.IJCCM_186_17.
  56. 56. Jialal I, Sokoll LJ. Clinical utility of lactate dehydrogenase: a historical perspective. Am J Clin Pathol. 2015;143:158-159. https://doi.org/10.1309/AJCTP0FC8QFYDFA.
  57. 57. Brancaccio P, Lippi G, Maffulli N. Biochemical markers of muscular damage. Clin Chem Lab Med. 2010;48:757-767. https://doi.org/10.1515/CCLM.2010.179.
  58. 58. Heidari Beigvand H, Heidari K, Hashemi B, et al. The value of lactate dehydrogenase in predicting rhabdomyolysis-induced acute renal failure; a narrative review. Arch Acad Emerg Med. 2021;9:e24. https://doi.org/10.22037/aaem.v9i1.1096.
  59. 59. Chandel A, Brusher K, Hall V, et al. Diagnosis and management of rhabdomyolysis in the absence of creatine phosphokinase: a medical record review. Mil Med. 2019;184:820-825. https://doi.org/10.1093/milmed/usz101.
  60. 60. Domańska-Senderowska D, Laguette MN, Jegier A, et al. MicroRNA profile and adaptive response to exercise training: a review. Int J Sports Med. 2019;40:227-235. https://doi.org/10.1055/a-0824-4813.
  61. 61. Mahtal N, Lenoir O, Tinel C, et al. MicroRNAs in kidney injury and disease. Nat Rev Nephrol. 2022;18:643-662. https://doi.org/10.1038/s41581-022-00608-6.
  62. 62. Cui SF, Wang C, Yin X, et al. Similar responses of circulating MicroRNAs to acute high-intensity interval exercise and vigorous-intensity continuous exercise. Front Physiol. 2016;7:102. https://doi.org/10.3389/fphys.2016.00102.
  63. 63. Bailey WJ, Barnum JE, Erdos Z, et al. A performance evaluation of liver and skeletal muscle-specific miRNAs in rat plasma to detect drug-induced injury. Toxicol Sci. 2019;168:110-125. https://doi.org/10.1093/toxsci/kfy282.
  64. 64. Harju AK, Bootorabi F, Kuuslahti M, et al. Carbonic anhydrase III: a neglected isozyme is stepping into the limelight. J Enzym Inhib Med Chem. 2013;28:231-239. https://doi.org/10.3109/14756366.2012.700640.
  65. 65. Burch PM, Greg Hall D, Walker EG, et al. Evaluation of the relative performance of drug-induced skeletal muscle injury biomarkers in rats. Toxicol Sci. 2016;150:247-256. https://doi.org/10.1093/toxsci/kfv328.
  66. 66. Stahl K, Rastelli E, Schoser B. A systematic review on the definition of rhabdomyolysis. J Neurol. 2020;267:877-882. https://doi.org/10.1007/s00415-019-09185-4.
  67. 67. Li J, Liu S, Hu Y, et al. Predicting mortality in intensive care unit patients with heart failure using an interpretable machine learning model: retrospective cohort study. J Med Internet Res. 2022;24:e38082. https://doi.org/10.2196/38082.
  68. 68. Zhou S, Lu Z, Liu Y, et al. Interpretable machine learning model for early prediction of 28-day mortality in ICU patients with sepsis-induced coagulopathy: development and validation. Eur J Med Res. 2024;29:14. https://doi.org/10.1186/s40001-023-01593-7.
  69. 69. Huang J, Jin W, Duan X, et al. Twenty-eight-day in-hospital mortality prediction for elderly patients with ischemic stroke in the intensive care unit: interpretable machine learning models. Front Public Health. 2022;10:1086339. https://doi.org/10.3389/fpubh.2022.1086339.
  70. 70. Liu C, Liu X, Mao Z, et al. Interpretable machine learning model for early prediction of mortality in ICU patients with rhabdomyolysis. Med Sci Sports Exerc. 2021;53:1826-1834. https://doi.org/10.1249/MSS.0000000000002674.
  71. 71. Poorsarvi Tehrani P, Malek H. Early detection of rhabdomyolysis-induced acute kidney injury through machine learning approaches. Arch Acad Emerg Med. 2021;9:e29. https://doi.org/10.22037/aaem.v9i1.1059.
  72. 72. El-Abdellati E, Eyselbergs M, Sirimsi H, et al. An observational study on rhabdomyolysis in the intensive care unit. Exploring its risk factors and main complication: acute kidney injury. Ann Intensive Care. 2013;3:8. https://doi.org/10.1186/2110-5820-3-8.
  73. 73. Candela N, Silva S, Georges B, et al. Short- and long-term renal outcomes following severe rhabdomyolysis: a French multicenter retrospective study of 387 patients. Ann Intensive Care. 2020;10:27. https://doi.org/10.1186/s13613-020-0645-1.
  74. 74. McMahon GM, Zeng X, Waikar SS. A risk prediction score for kidney failure or mortality in rhabdomyolysis. JAMA Intern Med. 2013;173:1821-1828. https://doi.org/10.1001/jamainternmed.2013.9774.
  75. 75. Kunakorntham P, Pattanaprateep O, Dejthevaporn C, et al. Detection of statin-induced rhabdomyolysis and muscular related adverse events through data mining technique. BMC Med Inf Decis Making. 2022;22:233. https://doi.org/10.1186/s12911-022-01978-4.
  76. 76. Cui X, Liu J, Zhang J, et al. In silico prediction of drug-induced rhabdomyolysis with machine-learning models and structural alerts. J Appl Toxicol. 2019;39: 1224-1232. https://doi.org/10.1002/jat.3808.
  77. 77. Lu Y, Neyra JA. How I treat rhabdomyolysis-induced AKI. Clin J Am Soc Nephrol. 2024;19:385-387. https://doi.org/10.2215/CJN.0000000000000372.
  78. 78. Sawhney JS, Kasotakis G, Goldenberg A, et al. Management of rhabdomyolysis: a practice management guideline from the eastern association for the surgery of trauma. Am J Surg. 2022;224:196-204. https://doi.org/10.1016/j.amjsurg.2021.11.022.
  79. 79. Michelsen J, Cordtz J, Liboriussen L, et al. Prevention of rhabdomyolysis-induced acute kidney injury - a DASAIM/DSIT clinical practice guideline. Acta Anaesthesiol Scand. 2019;63:576-586. https://doi.org/10.1111/aas.13308.
  80. 80. Chen F, Li D, Xu Y, et al. Effect of excitation-measurement pattern of planar electrode array on detecting crush injuries. 2024 IEEE International Instrumentation and Measurement Technology Conference (I2MTC). 2024.
Read More
Author biographies is not available.
Download
PDF
Statistic
Read Counter : 0 Download : 0