WHAT WILDLAND FIRE FIGHTERS NEED 

TO KNOW ABOUT RHABDOMYOLYSIS

Rhabdomyolysis (often called 

rhabdo) is the breakdown of 

damaged muscle tissue that 

releases proteins and electrolytes 

into the blood. These things 

can damage the heart and 

kidneys, result in permanent 

disability, and can even be fatal! 

Rhabdomyolysis can be caused 

by exertion and becoming 

overheated. Early treatment can 

prevent serious medical problems.

Because exertion in a hot environment is such 

a fundamental part of the job, fire fighters need 

to know the signs and symptoms of rhabdo 

to be able to quickly recognize the potential 

danger and get medical attention right away if 

they are not feeling well.

What can increase your risk 

for rhabdo?

+ Prolonged, intense physical exertion

+ Increased core body temperature

+ Some cold and allergy medications

+ Certain antibiotics

+ Dietary supplements, such as creatine

+ Common prescription medications such 

as statins that lower cholesterol

There are many risk factors for rhabdo 

and we still don ’t know all of them. 

You should check with your healthcare 

provider to ensure you don’t have any 

of the known risk factors for rhabdo.

People with no known rhabdo risk factors 

can get rhabdo. We don’t know enough to 

completely eliminate your risk for rhabdo. 

Photo by BLM-California

Centers for Disease Control

and Prevention

National Institute for Occupational 

Safety and Health
It can happen after activities you have done in the past 

without a problem. Even fire fighters who are in excellent physical condition can develop it. Always be on the 

lookout for signs and symptoms of rhabdo.

Seek medical evaluation right away if you 

have any of the following signs and 

symptoms of rhabdo: 

+ Muscle cramps, aches, or pains that are more 

severe than expected 

+ Inability to complete a workout routine due to 

feeling unusually tired

+ Tea- or cola-colored urine

Sometimes rhabdo symptoms do not appear until 

several days after the muscle is damaged. If you have 

any of these symptoms at any time, do not ignore them. 

Talk to your supervisor and seek medical treatment. 

Be sure to tell your healthcare provider about your job 

so they are aware of your increased risk for rhabdo.

How do I know if I have rhabdo?

You cannot tell by symptoms alone if you have rhabdo. 

The only way to know for sure is to see a licensed healthcare provider who can do a blood test for a protein called 

creatine phosphokinase (also called CK). CK is a muscle 

protein that is released into the blood when muscle 

tissue is damaged. Like the appearance of symptoms, the 

rise in CK may be delayed. Repeat blood tests are needed 

to know if the CK levels are going up or down.

Rhabdo may be confused with dehydration or heatrelated illnesses since these conditions can have the 

same symptoms. The only way to know if you have 

rhabdo is to have your CK checked.

How is rhabdo treated?

Less severe rhabdo can be treated with drinking more 

fluids, getting out of the heat, and resting. Serious cases 

of rhabdo need hospitalization to monitor heart and 

kidney function and to quickly treat any problem. Blood 

tests and EKGs help determine the severity of rhabdo.

Treatment of severe rhabdo includes intravenous (IV) 

fluids to flush out the muscle proteins and electrolytes. 

This treatment can prevent dangerous heart rhythms 

and loss of kidney function. If you do not get proper 

treatment quickly, the kidneys can become damaged 

and dialysis is sometimes needed. If kidney function 

does not recover, then a lifetime of kidney dialysis or a 

kidney transplant is required. You might need surgery to 

release pressure on damaged muscles to prevent permanent disability. If treated early,most rhabdo patients 

return to work in a few days without any lingering effects.

What can I do to increase my chances of a 

full recovery from rhabdo?

Listen to your body! Do your muscles hurt more than 

expected after a fire response or workout? Are you 

unusually fatigued? Is your urine darker than usual? If 

you have any of these symptoms, you should:

+ Stop your current activity right away, get out of 

the heat, and start drinking fluids

+ Tell your supervisor and any healthcare provider 

who evaluates you about your symptoms

+ Get to the nearest medical center immediately

+ Tell the healthcare provider you are a wildland 

fire fighter or give them this fact sheet

+ Ask to be checked for rhabdo

Reporting your symptoms could save your life and 

prolong your career! If you hear about or know of these 

signs or symptoms in a coworker, encourage them to 

report their symptoms and seek immediate medical care.

To receive information about other occupational safety 

and health topics, contact NIOSH: 

Telephone: 1-800-CDC-INFO (1-800-232-4636)

TTY: 1-888-232-6348

CDC-INFO: www.cdc.gov/info

or visit: www.cdc.gov/niosh

For a monthly update on news at NIOSH, subscribe to 

NIOSH eNews at www.cdc.gov/niosh/eNews.

DOI: https://doi.org/10.26616/NIOSHPUB2018131 

DHHS (NIOSH) Publication No. 2018-131

May 2018

Fire fighter having blood drawn. Photo by NIOSH