Fig. 2
From: Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice
Injury mechanisms of rhabdomyolysis. (1) Energy (ATP) depletion inhibits Na+/K+ ATPase function, thus increasing intracellular sodium. (2) The 2Na+/Ca2+ exchanger increases intracellular calcium. (3) Ca2+ ATPase is not able to pump out intracellular calcium due to energy depletion. (4) Intracellular calcium activates proteases such as phospholipase 2 (PLA2), which destroy structural components of the cell membrane, allowing the entrance of more calcium. (5) Calcium overload disrupts mitochondrial integrity and induces apoptosis leading to muscle cell necrosis