WHAT STRUCTURAL 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 activity

+ 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 etc.

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. It can happen after activities 

you have done in the past without a problem. 

Even fire fighters and athletes who are in 

Centers for Disease Control

and Prevention

National Institute for Occupational 

Safety and Health
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 with the amount 

of exertion

+ 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 chief and seek immediate 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?

The only way to know for sure if you have rhabdo 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 determine if 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 short-term 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, or is your urine unusually dark? If you have 

any of these symptoms, you should:

+ Stop your current activity right away, cool down, 

and start drinking fluids

+ If symptoms occur while at a fire, tell your chief 

and an on-site Emergency Medical Services 

personnel about your symptoms

+ If your symptoms start away from work, contact 

your healthcare provider or go to the nearest 

medical center immediately

+ Tell the healthcare provider you are a structural 

fire fighter or give them this fact sheet

+ Ask to be checked for rhabdo

Reporting your symptoms could save your life and 

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/NIOSHPUB2018133 

DHHS (NIOSH) Publication No. 2018-133

May 2018

Fire fighter having blood drawn. y NIOSHo bPhot