Freshwater fish ‘globally’ associated with risk of rhabdomyolysis

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According to the Western Journal of Emergency Medicine, the first case of rhabdomyolysis after ingesting certain types of fish was reported in 1924 in Europe. The journal states that Haff disease is defined as an illness in a person with “unexplained rhabdomyolysis who had eaten fish within 24 hours before symptoms onset”. Several case studies have since shed light on which types of fish may contribute to the dissolution of muscle fibres.

Doctor Chun Tang, Medical Director and GP at Pall Mall Medical, explained: “Rhabdomyolysis is a condition which is usually caused by direct and indirect muscle injury.

“It occurs when your muscle fibres are damaged and their contents are released into the bloodstream, which can be quite serious.

“Rhabdomyolysis can also lead to complications such as kidney failure as the kidneys become unable to remove waste and concentrated urine.”

The most common causes for the condition are excessive physical exertion and dehydration, but certain types of fish have also been linked to the disease.

The China CDC Weekly reported in 2020: “A common food that has been associated globally with rhabdomyolysis syndrome is freshwater fish including freshwater cod, barracuda, buffalo fish and pomfret.

“However, cases caused by freshwater fish have been relatively rare in China.”

In 2016, an investigation was conducted in a small Chinese village after six people fell ill after consuming a hotpot containing carp, vegetables, and dumplings together.

The carp had been caught from a pond earlier and prepared while retaining the testes, eggs and swim bladder.

The only person from the group who didn’t consume the vegetable and dumplings did not fall ill.

In order to verify the incidence and find the cause of the disease, a team of health professionals arrived at the scene for investigation on November 10.

The suspected cases all experienced the onset of muscle pain, fatigue, brown urine and other symptoms related to rhabdomyolysis.

The report explained the five other individuals experienced “an onset of symptoms indicative of rhabdomyolysis syndrome including vomiting, backache, lumbago and creatine kinase levels exceeding five times the normal range after dinner […]”.

Although the shared dinner is believed to be the culprit for the cluster event, the mechanisms of food-borne rhabdomyolysis remain poorly understood.

In fact, dietary sources are rarely linked to rhabdomyolysis.

Some case studies have suggested a link between dietary stimulants like caffeine and rhabdomyolysis.

“Excessive caffeine intake may increase the risk of this rhabdomyolysis,” explained Doctor Tang.

“Over time, excessive caffeine can damage the sarcoplasm (muscle fibre) which may, in turn, harms the muscle cells – resulting in rhabdomyolysis.”

What are the symptoms of rhabdomyolysis?

Doctor Tang explains: “There are different variations of symptoms of rhabdomyolysis – as depending on the cause, it can affect one concentrated area or even the whole body.

“Classic symptoms are muscle pain in the shoulders and thighs, lower back pain, brown or dark red urine, decreased urination and weakness in morning arms and legs.

“Other symptoms can include nausea, fever, rapid heart rates dehydration and confusion.”

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