[muscle Bx & comprehensive muscle lab & path link] Myoglobin is a muscle molecule leaked, released, or spilled from injured muscle into the blood stream (myoglobinemia) during muscle injury or rhabdomyolysis (destruction...lysis...of muscle cells). And, if blood levels are high enough, sustained or pulsed, myoglobin can spill through the glomeruli of the kidneys into the urine (myoglobinuria). Anything that will cause myoglobinuria will cause myoglobinemia. The initial clue to myoglobinuria may be the presence of a positive urine dipstick test for hemoglobin (the two globins cross-react). Symptoms associated with muscle injury include myalgia (muscle aches and pains) and flu-like symptoms. Many of these conditions will likely be associated with elevations of CPK and aldolase.

  Decreased Urine levels

• "negative" urine is "normal" (and negative serum is normal)

• Anything that causes rhabdomyolysis         

• Heredity Myoglobinuria:
  • Myophosphorylase deficiency (McArdle)
  • Phosphofructokinase deficiency (Tarui)
  • Carnitine palmityl transferase deficiency (DiMauro)
  • Phosphoglycerate kinase (DiMauro)
  • Phosphoglycerate mutase (DiMauro)
  • Lactate dehydrogenase (Kanno)
  • Incompletely characterized syndromes
    •  Excess lactate production (Larsson)
    •  Uncharacterized
  • Familial; biochemical defect unknown
    • Provoked by diarrhea or infection
    • Provoked by exercise
  • Malignant hyperthermia
  • Repeated attacks in an individual; biochemical defect unknown
• Sporadic or  acquired Myoglobinuria:
  • Exertion in untrained individuals
  • critical illness myopathy [LMC-05-3999].
  • "Squat-jump" and related syndromes
  • Anterior tibial syndrome
  • Convulsions
  • High-voltage electric shock, lightning stroke
  • Agitated delirium, restraints
  • Status asthmaticus
  • Prolonged myoclonus or acute dystonia
  • Crush syndrome
    • Compression by fallen weights
    • Compression  by body, prolonged coma
  • Ischemia
    • Arterial occlusion
    • Ischemia in compression and anterior tibial syndromes
    • Coagulopathy in sickle cell disease or disseminated intravascular  coagulation 
  • Ligation of vena cava 
  • Metabolic abnormalities
    • Metabolic depression
    • Barbiturate, carbon monoxide, narcotic coma
    • Diabetic acidosis
    • General anesthesia
    •  Hypothermia
  • Exogenous toxins and drugs
    • Haff disease: severe limb pain and myoglobinuria in Prussia  1924,1925,1940, ? due to a virus (a lagoon [Haff] connecting with Baltic Sea)
    • Ecstasy (MDMA) "club drug" overdose
    • Alcoholism
    • Malayan sea-snake bite poison
    • Plasmocid
    • Succinylcholine
    • Glucyrrhizate, carbenoxolone, amphotericin-B
    • Heroin
    • Phenylpropanolamine
    • statins:
      • monotherapy: 1 case in 22727 patient-years³
      • diabetics o a statin & fibrate: 1 in 484³.
      • cerivastatin & fibrate: 1 in 10³.
    • Neuroleptic malignant syndrome (NMS): apart from antipsychotics, NMS cases, including some that were fatal, have been reported in association with other drugs used in medicine that have neuroleptic properties. These include antiemetics (prochlorperazine), pro-peristaltic agents (metoclopramide), anesthetics (droperidol), and sedatives (promethazine). Although NMS has a variable onset and sometimes evolves rapidly, rigidity and altered mental status usually occur early, followed by autonomic changes and hyperthermia.8 In over 80% of cases, rigidity or mental status changes herald the onset of the syndrome.8 Specific early signs include obtundation, catatonia, tachycardia, tachypnea, labile blood pressure, dysarthria, dysphagia, diaphoresis, sialorrhea, incontinence, rigidity, myoclonus, tremors, low grade fevers or serum creatine kinase elevations.
  • Chronic hypokalemia of any cause
  • Heat stroke
  • Toxic shock syndrome
  • Progressive muscle disease ("polymyositis"," alcoholic myopathy," "necrotizing myopathy" ) [LMC-00-7020]
  • Cause Unknown

Other names for this exact or approximate agent are:   

• myoglobinuria

Reference: 

1. Dr. Rowland's section in Merritt's textbook of Neurology
2. Thompson PD, "Statin Associated Myopathy", JAMA 289(13):1681-1690, 2 April 2003.
3. Graham DJ, et.al., "Incidence of Hospitalized Rhabdomyolysis...[Statin Associated]", JAMA 292(21):2585-2590, 1 December 2004.

(posted 2001; latest addition 12 April 2007)