Clinical outcomes of hospitalised individuals with spin-induced exertional rhabdomyolysis

Abstract

Introduction: Exertional rhabdomyolysis (ER) is caused by myocyte breakdown after strenuous physical activity. In recent years, the incidence of spin-induced ER (SER) has been increasing. We describe the clinical characteristics, management and outcomes of patients admitted for SER. Method: A review was conducted for all patients admitted to Singapore General Hospital for SER from 1 March 2021 to 31 March 2022. All patients with the admission diagnosis of “rhabdomyolysis”, “raised creatine kinase (CK) level”, or “elevated CK level” with a preceding history of spin-related physical exertion were included. Patients without a history of exertion, with a history of non-spin related exertion, or with a peak serum CK <1000 U/L were excluded. Results: There were 93 patients in our final analysis; mean age was 28.6±5.6 years and 66 (71.0%) were female patients. Mean body mass index was 25.0±5.7 kg/m2; 81 (87.1%) patients were first-time spin participants. All patients had muscle pain, 68 (73.1%) had dark urine, 16 (17.2%) muscle swelling and 14 (15.1%) muscle weakness. There were 80 (86.0%) patients with admission CK of >20,000 U/L. Mean admission creatinine was 59.6±15.6 μmol/L. Mean intravenous (IV) hydration received was 2201±496 mL/ day, oral hydration 1217±634 mL/day and total hydration 3417±854 mL/day. There was 1 (1.1%) patient with acute kidney injury, which resolved the next day with IV hydration. Conclusion: Inpatient management of SER includes laboratory investigations, analgesia and hydration. Risk of complications is low in SER patients. SER patients without risk factors for complications can be considered for hospital-at-home management with bed rest, aggressive hydration and early outpatient review.

Incidence of Electrolyte Imbalances Following Traumatic Rhabdomyolysis: A Systematic Review and Meta-Analysis

“…Among 28 included articles [ 15 - 20 , 22 , 23 , 25 - 27 , 29 - 41 , 43 - 46 ] that reported the number of hyperkalemia patients, the main cause of rhabdomyolysis was being trapped under rubble due to an earthquake. Additional details regarding the causes and features of these records can be found in Table 2 .…”

“…Additional details regarding the causes and features of these records can be found in Table 2 . In 16 of these studies, rhabdomyolysis was diagnosed on a clinical basis [ 17 , 18 , 20 , 26 , 27 , 30 , 32 - 35 , 37 - 41 , 44 , 46 ], and in the rest, different serum levels of CPK were used [ 15 , 16 , 19 , 22 , 23 , 25 , 29 , 31 , 36 , 43 , 45 ]. In 16 studies, serum potassium was checked on the day of admission [ 16 , 22 , 29 - 33 , 36 , 37 , 39 , 40 , 43 - 46 ], it was checked during patients’ hospital stay in six of them [ 17 , 18 , 23 , 25 , 27 , 38 ], and in the remaining six, the authors didn’t mention anything about the timing of the test [ 15 , 20 , 26 , 34 , 35 , 41 ].…”

“…Among the 13 articles that reported the number of hypokalemia patients [ 15 , 16 , 19 , 20 , 22 , 24 , 26 , 27 , 29 - 31 , 36 , 37 , 43 ], five studied patients with rhabdomyolysis caused by exertion [ 15 , 19 , 22 , 26 , 43 ], and six reviewed rhabdomyolysis caused by being trapped under rubble after an earthquake [ 16 , 27 , 30 , 31 , 36 , 37 ]. In eight of these studies [ 16 , 19 , 22 , 27 , 30 , 31 , 37 , 43 ], hypokalemia was defined as having a serum potassium level lower than 3.5 mEq/dL, while other studies did not mention how hyperkalemia was defined.…”

“…Our meta-analyses included seven articles that reported the number of hypercalcemic patients [ 15 , 20 , 24 , 30 , 31 , 43 , 45 ] and 12 articles that reported the number of hypocalcemic patients [ 15 , 20 , 21 , 24 , 30 , 31 , 39 - 43 , 45 ] (Tables 6 , 7 ).…”

“…Among seven articles that reported the number of patients with hypercalcemia [ 15 , 20 , 24 , 30 , 31 , 43 , 45 ], the cause of rhabdomyolysis in three of them was being trapped under rubble [ 24 , 30 , 31 ], two of them were heavy exertion [ 15 , 43 ], one of them was being beaten [ 45 ], and one was due to heat stroke [ 20 ]. The calculated pooled incidence of hypercalcemia among patients diagnosed with rhabdomyolysis was 0% (95%CI: 0%-1%, heterogeneity I2:48.37%) (Figure 6 ).…”