Stimulants causing Rhabdomyolysis: how dangerous is this?

[Alfa]

Ephedra/ephedrine & other stimulants have been used to give athletes more energy and thus allowing them to do more training. But when Ephedra/ephedrine is used this way, it is said to cause rhabdomyolysis(muscle cell break down). So this is actually the opposite of what a body builder would want to achieve.

When users of psychedelics and stimulants are restrained & tied down by authorities, rhabdomyolysis also occurs. (Often this is attributed to the effects of the drug, instead of the actions of the authorities.)

My question is:

How real is the threath of rhabdomyolysis in regards to stimulant use and which situations should be avoided?

FYI:
Definition of Rhabdomyolysis

Rhabdomyolysis: A condition in which skeletal muscle cells break down, releasing myoglobin (the oxygen-carrying pigment in muscle) together with enzymes and electrolytes from inside the muscle cells. The risks with rhabdomyolysis include muscle breakdown and kidney failure since myoglobin is toxic to the kidneys.
Rhabdomyolysis can occur from extensive muscle damage as, for example, from a crushing injury or an electrical shock. Drugs or toxins, particularly some of the cholesterol lowering medications such as cerivastatin (Baycol), may cause this disorder. Underlying diseases such as systemic lupus erythematosus can also lead to rhabdomyolysis. It is a common complication of major burns.
The key signs and symptoms of rhabdomyolysis include dark, red, or cola colored urine and muscle tenderness, stiffness, aching (myalgia) or weakness. Laboratory confirmation can come from the demonstration of myoglobin in the blood or urine.
Ideal treatment involves early and aggressive hydration with very large amounts of IV fluids to flush the myoglobin out of the kidneys. Diuretics may help. So may bicarbonate which makes the urine alkaline to prevent the breakdown of myoglobin into more toxic compounds. From the Greek roots rhabdo-, striped (striated) + -myo-, muscle + -lysis, breakdown = the breakdown of striated muscle (skeletal muscle).

[stoneinfocus]

If you´re well trained there´s no such danger imho.

there should be neurolpetics listed as well then, because obvoiusly detroying all the ATP in you rmuscle fibers and sky-rocketing creatinine-kinase doesn´t seem tooo healthy and pleasurable to any man who has his sense together and trying to train while on those meds might result in the same condition as described if not directly then from the sides of those.

[Nicaine]

Keyword: Harm Reduction

Good question Alfa... I did some research in this area (fwiw I was a hired researcher for the Google Answers service, which recently shut down) and offer some links here for those interested in this topic.

http://www.kfshrc.edu.sa/annals/186/98-069.html
"DRUG-INDUCED RHABDOMYOLYSIS," E.B. Larbi, MB, PhD, FRCP

http://members.tripod.com/~baggas/rhabdo.html
"...This is actually a copy of an assignment I did for my fourth year medicine neuropathology course back in 1997."

http://www.pubmedcentral.nih.gov/art...?artid=1126495
"Rhabdomyolysis - Has many causes, including statins, and may be fatal,"
Russell Lane, consultant neurologist and Malcolm Phillips, consultant nephrologist

http://www.emedicine.com/EMERG/topic508.htm
"Rhabdomyolysis," Sandy Craig, MD, Associate Program Director, Adjunct Assistant Professor, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Carolinas Medical Center

As far as self-treatment if rhabdomyolysis is noticed -- as usual, the drug-using population is assumed to be stupid, ignorant and incompetent in respect to their own bodies (no surprise, as the necessary information is withheld and learning is discouraged). Rewording/refining the final paragraph of Alfa's post -- combining diuretics with *gradual* intake of large quantity of fluids (plus electrolyte tablets to prevent hyponatremia) may help, along with bicarb loading (simple baking soda could do it) to alkalinize urine and prevent the breakdown of myoglobin into more toxic compounds. However, avoiding dangerous electrolyte imbalances could be difficult, and getting to the ER ASAP should be a high priority.

[toe]

Before my boogieman suffered rhabdo, she was under the impression that this syndrome was nearly exclusive to compartment syndrome in athletes. Acute CS must be treated within hours to prevent muscle necrosis of most/all of the contents of the compartment. (This can be as simple as elevation and ice, but fasciotomy to release the pressure manually is indicated as treatment for CS not responding to non-instrusive measures with a known onset of less than 24 hours*) But the first concern with rhabdo is correction of ARF, and- unfortunately- a drug user's risk of losing a limb to undiagnosed CS is often overlooked in the trauma center. (Because CS hurts like a bitch, so complaints of local pain are ignored a drugseeking despite the undeniable visual signs of legitimate syndrome.)


Monsters, Inc. has since learned that CS is not uncommon in methadone overdoses where a subject has been down for several hours. Apparently rhabdo is also an issue in uncontrolled Diabetes Mellitus, but it would appear that the latter develops in a chronic manner. It sounds as though rhabdo in amphetamine abuse would follow the same pattern.

My lawyers have informed me that life-threatening rhabdo tends to result primarily from extreme trauma and/or extreme carelessness. They disagree with co-incidence that it's possible to train oneself against the clumsiness, self-loathing, and stupidity that would prevent acute rhabdomyolysis from overdoses of drugs or underdoses of insulin.

However, it would certainly seem that death from rhabdomyolysis resulting from chronic use of amphetamines is extremely unlikely. The danger of death from kidney failure results from sudden massive release of dead muscle tissue into the bloodstream, and you'd have to kill off a foot or something to cause this.

Or so I've heard. And gathered from snooping through some confidential medical files.


*There's dissent- the range of faith in positive outcomes for surgical outcomes from surg. intervention range from 12-48 hours post-onset.