Acute Kidney Injury From Heat Illness - Rugby Union (7-players-a-side)

Abstract

HISTORY: A 30-year-old men’s club Division I Rugby-7s winger sustained abdominal cramping and profuse sweating at tournament end. Player reported these symptoms from exertional demands of the sport. Player noted, he aided hydration throughout the tournament (Local Temp=91F) with water and electrolyte supplementation with “sports drinks.” Diet included fruits, candy, and meats during tournament. Player denies difficulty urinating, yet described urine to be dark in color. No significant medical history, but noted comparable cramping events that occurred approximately 2½ months prior, as well as, 2-years ago with no medical intervention. Six National Championship tournament matches (each match lasted 14 minutes) later he advised the team doctor. PHYSICAL EXAM: Examination post tournament, reflected profuse diaphoresis and abdominal muscle cramping at end of tournament. Patient transferred to local ED, where exam revealed an alert player in no acute distress, mild Temp=98.3F, BP=136/89, Pulse=66, PO2=98, cool to touch and mildly diaphoretic. Player had generalized abdominal muscle cramping. No lower or upper extremity muscle presentation. Blood was drawn and urine collected. Post-IV infusion patient noted cessation of abdominal cramping and tolerated perioral ingestion. Repeated blood labs. DIFFERENTIAL DIAGNOSIS: 1. Acute kidney injury 2. Exertional rhabdomyolysis 3. Heat illness TEST AND RESULTS: Urinalysis: Yellow, +protein, +hyaline casts, +ketones, +RBC’s, +UA crystals. Preliminary Blood test: BUN=29, creatinine =2.3, AST=42 and CK=1581 Repeat Blood test (post IV Fluids): BUN=27, creatinine=1.7, Glucose=42 and CK=1617 FINAL WORKING DIAGNOSIS: Acute kidney injury (Stage 2) with rhabdomyolysis 2ndry to Heat Exhaustion TREATMENT AND OUTCOMES: 1. Emergency. Immediate removal from play to avoid progression and transfer to ED for rapid IV bolus. 2. Serial blood work, noting elevated BUN, creatinine and CK of stage 2 AKI, with decrease post IVF, urinalysis reflected of dehydration, and monitoring 3. Discharged to self-care and advised to return if necessary, to ED with complaints of fever, inability to urinate, back pain, discolored/blood in urine, or other new symptoms. 4. Returned to sport 3-weeks post-injury with no sequalae and able to meet the demands of his sport.