Case Of Exertional Rhabdomyolysis Research Articles

A Case of Exertional Rhabdomyolysis in an 11-year-old Argentine Mare ‎

Exertional Rhabdomyolysis is an imbalance between the animal's diet and its workload, especially when on a high-grain diet. An 11-year-old Argentine mare weighing 360 Kg was presented with a complaint of pyrexia, anorexia, pointed stance and stiff gait, reluctance to move and trembling when compelled to walk. On physical examination, body condition score of 2.5/5, excessive sweating, stiff hind quarters, and reluctance to move were observed. On clinical examination, the animal showed tachypnea, congested ocular mucous membrane and a temperature of 38.9oC. Blood sample was taken for complete blood cell count and biochemical test. The result of haematological test was within normal range while the biochemical test revealed hypoglycemia, hypochloremia, hyponatremia and hypokalemia. The levels of calcium, creatine kinase and bicarbonate were higher than the normal range. A diagnosis of azoturia was made based on history, clinical signs and laboratory test. The movement of the horse was restricted and it was treated with 0.6 mg/kg meloxicam daily for 5 days, 0.2mg/kg dexamethasone daily for 2 days, 12 ml of VitESe daily for 3 days and 60ml of Promin® daily for 3 days. The horse was given gentle walking exercise and low carbohydrate diet during the treatment period and normal function of the horse gradually returned 4 weeks after presentation. It was concluded that exertional rhabdomyolysis can be managed by administration of analgesic and anti-inflammatory, restricted carbohydrate diet and limited exercise until muscle function returns to normal.

Return to Play for Exertional Rhabdomyolysis in Korea National Rugby Player

This case report describes the process of returning to play as a case of exertional rhabdomyolysis caused by excessive training by a national rugby player. The authors reported the serum analysis, urinalysis, visual analog scale for pain, and lower-extremity functional scale. The aspartate aminotransferase, alanine transaminase, and myoglobin levels in the serum analysis decreased normally during the eighth day, and creatine phosphokinase levels decreased to normal levels by the 15th day. The maximal scale of visual analog scale for pain was 10 from the third day to the fifth day, and gradually decreased from the sixth day (scale = 6.6) to the 13th day (scale = 0.9). The lower-extremity functional scale scores after the diagnosis of exertional rhabdomyolysis were 0 at the third day, 47 at the 10th day, and 80 at the 24th day. A moderate increase in water intake could help the player recover faster. To restore overall body condition for rugby performance, specific athletic therapy and training should be provided at a predetermined specific time.

Twelve cases of exertional rhabdomyolysis in college football players from the same institution over a 23-year span: a descriptive study

ABSTRACTBackground: Rhabdomyolysis is a syndrome characterized by muscle necrosis that leads to release of the intracellular contents of muscle cells into the systemic circulation. Rhabdomyolysis due to overexertion is an uncommon but well-known severe complication of strenuous activity. Exertional rhabdomyolysis (ER) is typically described in weight lifters and military recruits undergoing basic training. Few cases have been reported in football players without known predisposing risk factors. We report our experience with this condition in college football players in a single institution.Materials and methods: College football players hospitalized for heat illness complicated by rhabdomyolysis were identified over a 23-year period. Clinical and laboratory findings were collected. Clinical course was recorded.Results: Twelve patients were identified. All were Black males. One had sickle cell trait. BMI averaged 33 kg/m2 (range 23–45 kg/m2). Peak creatine phosphokinase (CPK) averaged 14,850 IU/L (range 1,021–109,616 IU/L). Serum creatinine averaged 1.9 mg/dl (range 1.2–3.1 mg/dl). Ten of twelve cases occurred in August. All responded to intravenous hydration with normalization of CPK and renal function. All returned to football.Conclusions: ER is a serious complication of strenuous physical activity that can threaten renal function. ER tends to occur in August, which coincides with the start of football practice when athletes are more likely to be detrained. The condition can occur in Black athletes in the absence of sickle cell trait. ER carries a good prognosis when recognized early and treated adequately.

Exertional Rhabdomyolysis of the Elbow Flexor Muscles From Weight Lifting

Ultrasound imaging of rhabdomyolysis previously has been reported in the literature, but differing descriptions of its appearance exist. In this report, we describe a relatively rare case of exertional rhabdomyolysis of the anterior arm muscles. This injury may appear sonographically different than more severe cases of rhabdomyolysis. Our patient was a young, active individual participating in a weight-lifting exercise as part of a physiology laboratory experiment. Ultrasound was helpful to assist in the diagnosis and rule out other conditions. He was treated conservatively and eventually made a complete recovery.

Skeletal Muscle Physiology

In the beginning of the last century, muscle proteins were viewed as static structural molecules not capable of being utilized by other tissues or organs. This concept was accepted until the 30s, where Rudolf Schoenheimer presented strong evidences about the “Dynamic State of Body Constituents,” which means that skeletal muscle is not only capable of contracting but also capable of releasing nitrogen derived molecules to be utilized by other organs and tissues (Guggenheim, 1991) [1]. Such concept established that skeletal muscle is a highly plastic tissue, adapting its structure and metabolism in response to diverse conditions such as contractile activity, mechanical overload, and nutrients. From this point of view several questions arise, specifically, how form follows function of skeletal muscles, as well as the synergistic role of nutrients. A large number of research groups around the world are helping to clarify this and many other questions. In particular in the last four decades, the growth in the number of publications on skeletal muscle subject is noteworthy (Figure 1). Figure 1 Number of publications in Medline database with “skeletal muscle” present on title. Data from the US National Library of Medicine National Institutes of Health (http://www.ncbi.nlm.nih.gov/pubmed?term=skeletal%20muscle [Title]). ... In this special issue, the reader will be brought directly to a wide spectrum of articles regarding the skeletal muscle tissue. From France, a new hypothesis concerning how to consume amino acids and deal with catabolic conditions also is put in debate, focusing on the anabolic threshold concept (D. Dardevet et al., 2012). From the University of Tokyo, Japan, A. Wagatsuma and K. Sakuma (2013) summarize the current knowledge about the role of mitochondria as a regulator of myogenesis. From Brazil, C. O. Assumpcao et al. (2013) present an extensive review on the effects of exercise-induced muscle damage on running economy in humans. Also, W. S. Dantas et al. (2013) discuss the impact of polycystic ovary syndrome on skeletal muscle tissue. A. Carsana (2013), from Italy, reviewed the documented cases of exertional rhabdomyolysis or stress-induced malignant hyperthermia and reported a possible association with RYR1 gene polymorphism. This special issue also presents original articles focusing on the cytokine response of skeletal muscle cells according its differentiation stage (M. Podbregar et al., 2013), the effects of tissue culture conditions on in vitro myogenesis (S. Hinds et al., 2013) and the differences in spontaneous physical activity between mice substrains (D. Coletti et al., 2013). All these discussions are being provided in order to generate new benefits and from athletes to debilitated populations; from basic to applied sciences. In this issue, our focus was not to restrict but, on the contrary, to be capable of proposing new hypotheses and ideas based on the current knowledge.

Rhabdomyolysis in a Collegiate Football Player

Rhabdomyolysis is a serious, potentially life threatening condition that can develop unexpectedly under supervised training conditions. Here we present a case of exertional rhabdomyolysis occurring in a healthy, fit 18-year-old placekicker following a supervised practice session led by the team's strength and conditioning coach. The day after this session, the player experienced extreme pain and dark urine and sought treatment at a local emergency department. Hospitalization resulted in a diagnosis of rhabdomyolysis based on myoglobinuria, muscle pain, and extremely elevated circulating creatine kinase values (>130,000 IU x L(-1)). Following eight days of hospitalization with intravenous fluids, the patient recovered without complications. This case illustrates that rhabdomyolysis can occur after strenuous exercise in the absence of dehydration in otherwise conditioned and healthy athletes.

CrossRef Listing of Deleted DOIs

Recreational activity frequently produces large increases in circulating CK activity without consequence. Thus, high CK levels alone do not portend renal failure. Most cases of exertional rhabdomyolysis can, and probably do, resolve on their own without treatment. When taking a blood sample during a routine check, for example in monitoring patients on statin therapy, a high blood CK activity may indicate that strenuous exercise was performed in the previous 10 days. Patients should be queried as to their exercise history during this time. Snow shoveling, dirt shoveling, lifting and lowering heavy boxes, strenuous resistance training, and excessive calisthenics (such as push-ups and pull-ups) are exercises that may dramatically increase circulating CK activity for several days due to forceful eccentric contractions. In addition to elevated CK, factors such as underlying disease, dehydration, environmental heat stress, or genetic predisposition (eg, sickle cell trait) are likely required for exertional rhabdomyolysis to result in acute renal failure [8]. Persons who present to the emergency room with painful, swollen muscles about 2 days after a bout of strenuous exercise should be monitored for kidney function (BUN and creatinine), evidence of myoglobinuria and dehydration, and be queried regarding hydration, heat stress during the exercise, and possible trauma. In cases of exertional rhabdomyolysis, especially in laboratory situations, CK levels up to 100,000 U/L in the absence of nephrotoxic factors have been found to resolve without consequence when no treatment is provided. However, because few data confirm this in a clinical situation in which there may be comorbidities, it remains conservative and prudent in the emergency room to hydrate intravenously and monitor closely to help avoid hyperkalemia and/or acute renal failure in the face of fulminant exertional rhabdomyolysis.

Exertional rhabdomyolysis and renal failure in patients with sickle cell trait: Is it time to change our approach?

Based upon numerous reported cases and despite widespread beliefs to the contrary, sickle cell trait (SCT) may be deemed a quantifiable risk factor in certain subsets of patients. As a result of common misconceptions regarding SCT, most individuals with the condition are generally not informed regarding the possible consequences of certain activities such as venturing to high altitudes or participating in overly exertional physical activities. Acute exertional rhabdomyolysis is a potentially serious clinical illness and is caused by skeletal muscle injury resulting in the release of myoglobin and other cellular contents, including creatine kinase, into the circulatory system. Mild to moderate cases of acute exertional rhabdomyolysis can cause metabolic disorders including hypernatremia, hyperkalemia, hyperphosphatemia, hypocalcemia, lactic acidosis and hyperuricemia. Severe cases may result in renal failure and even death. Several case reports have been published since the early 1970s describing significant morbidity and mortality of acute exertional rhabdomyolysis in patients with SCT. We present the case of a 27-year-old male with a past medical history significant only for SCT who presented after a 1.5 mile run with severe exertional rhabdomyolysis and subsequent acute renal failure requiring hemodialysis (HD). In presenting this case, we hope to raise awareness of a possible underlying cause to many cases of exertional rhabdomyolysis and encourage physicians to counsel their patients with SCT in order to avoid the significant morbidity and mortality that may be associated with the condition.

Exertional Rhabdomyolysis

Exertional Rhabdomyolysis

Case Report of Exertional Rhabdomyolysis in a 12-Year-Old Boy

Exertional rhabdomyolysis has been well characterized, and many case reports exist. No cases of exertional rhabdomyolysis in young healthy children (preteen) have been published. Reviewed were the medical records of a 12-yr-old boy who participated in an indoor physical education class where excessive (>250) repetitive squat jumps were performed as punishment for talking in class. The boy, who reported intense muscle soreness in the thighs and dark urine 2 d postexercise, was brought to the emergency room by his parent. His serum creatine kinase (CK) was 92,115 U.L(-1) and urinalysis indicated the presence of blood and protein. He was transferred to another hospital that evening, admitted, and treated for 7 d. His serum CK rose to 244,006 U.L(-1) at 4 d postexercise. Although exertional rhabdomyolysis is rare in young children, it can occur when excessive exercise is spurred on by an adult.