Evaluation of Clinical Outcomes in Hospitalized Patients With Exertional Rhabdomyolysis

Abstract

Context: Exertional rhabdomyolysis (ER) is a medical condition in which excessive and unaccustomed physical activity results in skeletal muscle damage in otherwise healthy individuals. Objective: To assess the overall outcomes of patients who presented to the emergency department with ER. Methods: This retrospective study was conducted across 4 hospitals. The study included nonpregnant adults with no history of renal function impairment or myopathy disorder who had a diagnosis of ER in the emergency department setting. Medical records were reviewed for patient demographics, length of stay, complications, mechanism(s) of injury involved, impact of nutritional supplements, spectrum of creatine kinase (CK) responses, prevalence of hospital readmissions, and overall mortality. Results: Of the 800 rhabdomyolysis cases identified during the 24-month study period, 41 were included in the study. The mean age was 29 years, and the patients were predominantly male (33 [80.5%]) and white (25 [61%]). The median length of stay was 2 days, and it correlated significantly with initial and peak CK levels (R=0.45, P=.004, and R=0.52, P<.001, respectively). Median initial and peak CK were noted to be 16,888 (range, 342-194,403) U/L and 18,534 (range, 342-287,565) U/L, respectively. Median discharge CK was 5287 (range, 10-61,617) U/L. The most commonly cited mechanism of injury was weight lifting (16 [39%]). In terms of overall outcomes, transient kidney injury was noted in 3 cases (7.4%), and no mortality was recorded during the admission or at 12 months of follow-up. Compartment syndrome or severe electrolyte abnormalities were not observed. There were only 2 uncomplicated readmissions (4.8%) due to high-intensity interval training. Conclusion: Hospitalized patients with ER without a history of renal impairment tend to have relatively low risks of complications and readmission.

Serum creatine kinase levels are not associated with an increased need for continuous renal replacement therapy in patients with acute kidney injury following rhabdomyolysis

“…Two retrospective reviews of 30 and 41 cases based on exertional RM-associated AKI, found discharged CK values ranging from 1,410 to 94,665 U/L and 10 to 61,617 U/L [ 30 , 31 ]. Mario Pezzi et al.…”

More than myalgia: An unusual presentation of exertional rhabdomyolysis

“…Some experts have argued that discharge at higher CK thresholds of 20 000 to 50 000 U/L can be safely achieved in the ED, whilst others have recommended hospitalisation for rhabdomyolysis until CK level drops to less than 1000 U/L. 20 Outpatient management with oral hydration may suffice for a stable patient with a CK level of 20 000 U/L to 50 000 U/L (and possibly higher), normal creatinine level and good urine flow. 21 In a study carried out on 41 patients presenting with ER, the median discharged CK was 5287 (range, 10-61 617) U/L with a mean length of stay of approximately 3 days.…”

Serum Creatine Kinase Levels are not Associated with an Increased Need for Continuous Renal Replacement Therapy in Patients with Acute Kidney Injury Following Rhabdomyolysis

“…Two retrospective reviews of 30 and 41 cases about exertional RM-associated AKI, found discharged CK values ranging from 1,410 to 94,665 U/L and 10 to 61,617 U/L [30,31]. Mario Pezzi et.al (2017) reported case series about the use of coupled plasma ltration adsorption (CPFA) in traumatic RM, and the lowest CK level was 9,000 U/L, and the highest level was 20,000 U/L when CPFA stopped [11].…”