Patients in Rhabdomyolysis Presenting to the Emergency Department

Rhabdomyolysis is a disorder of muscle breakdown that can cause acute renal failure. Although mostly associated with intense exercise and prolonged immobility, other causes precipitate rhabdomyolysis. This study aims to describe emergency department (ED) patients with rhabdomyolysis, specifically identifying those with substance abuse and associated compartment syndrome.

This is a retrospective descriptive review of patients who presented to 2 South Florida EDs between January 2017 and December 2018. Patients were included if they had a creatine phosphokinase level ≥1000 or an ED diagnosis of rhabdomyolysis. We identified the most common immediate and proximate causes of rhabdomyolysis for these patients. Additional factors evaluated included presenting complaints, symptoms, and drug and alcohol use.

There were 308 patients included. Immediate causes were injury/prolonged immobility (58.1%), neurologic/psychiatric (18.2%), and intentional exercise (16.2%). Proximate causes were illicit drug use (28.6%) and infectious diseases (16.9%). The most frequent presenting complaints associated with rhabdomyolysis included muscle pain (21.4%), unresponsive without a clear etiology (20.8%), altered mental status (17.5%), and nonsyncopal fall (17%). Most common symptoms included generalized fatigue and weakness (47.1%), altered mental status (29.2%), extremity pain (24.7%), and diffuse body aches (21.1%). Drug and alcohol use were prevalent at 24.0% and 29.9%, respectively.

Although pressure injuries and exercise were the most common causes identified, rhabdomyolysis was also frequently caused by hyperactive delirium with severe agitation. In all patients with proximate causes identified, many had substance use. This descriptive analysis provides emergency physicians with the clinical characteristics of patients who present with rhabdomyolysis.