Exertional rhabdomyolysis in a 21-year-old healthy man resulting from lower extremity training

Peng, Fenfen; Lin, Xuexin; Sun, Lijuan; Zhou, Weidong; Chen, Yihua; Li, Peilin; Chen, Ting; Wu, Jiayu; Xu, Zuojun; Long, Haoyu

doi:10.1097/md.0000000000016244

Cited by 8 publications

(9 citation statements)

References 30 publications

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“…Vigorous unaccustomed exercise can result in severe rhabdomyolysis and AKI (18,19). Exercise-related rhabdomyolysis occurred in three patients in our study, with two developing AKI.…”

Section: Discussionmentioning

confidence: 53%

Causes and outcome of rhabdomyolysis in patients admitted to medical wards in the Prince of Wales Hospital

Zeng

Tomlinson²

2021

Ann Transl Med

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Background: Rhabdomyolysis with a marked elevation of serum creatine kinase (CK) can be caused by various conditions. Acute kidney injury (AKI) is a potential complication of severe rhabdomyolysis and leads to a rapid increase in serum creatinine. Methods: This study was performed to identify medical cases diagnosed with rhabdomyolysis and to examine the likely causes. Patients diagnosed with rhabdomyolysis during admission to the medical wards of Prince of Wales Hospital (PWH) in Hong Kong from January 1, 2004 to May 31, 2012 were identified by searching computer records. Details of hospital admissions were retrieved, and the underlying causes of the rhabdomyolysis and clinical outcomes were analyzed.Results: There were 95 Chinese patients with a median age of 72 years (range, 22-92 years) assigned a diagnosis of rhabdomyolysis. A mild degree of AKI was defined as an increase of serum creatinine more than 20% above the baseline value before onset of acute illness and with the highest creatinine greater than 120 µmol/L. Mild AKI was identified in 63 patients. Rhabdomyolysis appeared to contribute to a fatal outcome in eight patients who had multiple preexisting morbidities. The maximum CK had a median value of 9,829 U/L (range, 472-258,100 U/L). Twelve patients with peak CK levels <10× the upper limit of normal (ULN) may not have had rhabdomyolysis by this standard definition. Of the remaining 83 patients with maximum CK values >10× the ULN, the most common contributing factors were trauma (n=19) and infection (n=17). Other common underlying causes included drug abuse (heroin and alcohol) and ischemia/ immobility.Conclusions: Most patients recovered with appropriate medical interventions and had a median hospital stay of 13 days. One patient was thought to have drug-related rhabdomyolysis due to taking bezafibrate during an episode of renal impairment.

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“…Vigorous unaccustomed exercise can result in severe rhabdomyolysis and AKI (18,19). Exercise-related rhabdomyolysis occurred in three patients in our study, with two developing AKI.…”

Section: Discussionmentioning

confidence: 53%

Causes and outcome of rhabdomyolysis in patients admitted to medical wards in the Prince of Wales Hospital

Zeng

Tomlinson²

2021

Ann Transl Med

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“…Currently, there are no fixed guidelines for rhabdomyolysis management. Nevertheless, because acute kidney injury is the most common complication, early oral rehydration and intravenous isotonic solution are the mainstays of rhabdomyolysis treatment in order to preserve renal function [5,14].…”

Section: Discussionmentioning

confidence: 99%

CrossFit-Induced Rhabdomyolysis in a Young Healthy Indonesian Male

Lawrensia¹,

Henrina²,

Cahyadi³

2021

Cureus

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CrossFit, a high-intensity interval training, keeps growing in trend and is one of the most favorable types of fitness, after wearable technology. However, an excessive workout is detrimental to the human body, particularly the muscle tissue. CrossFit is known to cause exercise-induced rhabdomyolysis, a concerning disease with potentially devastating consequences. Nevertheless, only a few case reports have described this disease, and this is the first case report of such disease in Indonesia to the best of our knowledge.A 27-year-old, previously healthy and active Indonesian male presented with dark urine and myalgia in lower extremities after 720 repetitions of squats three days before admission. His urinalysis showed +1 blood, 2-7 red blood cells/high power field (HPF), but negative protein. Laboratory results showed an increase in creatine phosphokinase (CPK) (54,250 U/L) and LDH (1,670 U/L) levels, consistent with exerciseinduced rhabdomyolysis, and serum calcium of 1.87 mmol/L, with normal serum creatinine and BUN level. He was hospitalized for two days and was treated with intravenous hydration therapy.CrossFit-induced rhabdomyolysis is a potentially devastating disease. Apart from prompt diagnosis and treatment, further research regarding the safe number of repetitions for CrossFit training, particularly for lower extremities are needed. Predictors of CrossFit-induced rhabdomyolysis must be sought throughout, and participants' awareness should be increased.

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“…Rhabdomyolysis could lead to disturbance of the kidneys. 22 Especially, if a high-protein diet is consumed this could lead to a further deterioration of the renal function 36 For this reason, we measured serum levels of creatinine and urea as biomarkers of renal clearance and nitrogen balance (Figure 3). Both factors were unaffected by the high-protein supplementation and the WB-EMS treatment.…”

Section: Biomarkers Of Protein Metabolism and Renal Healthmentioning

confidence: 99%

“…21 For WB-EMS there are several investigations on acute WB-EMS effect mainly based on case reports. [22][23][24][25][26][27] Indeed, due to its ability to stimulate large muscle areas simultaneously and with regionally dedicated, in excess, supramaximal stimuli, WB-EMS might be the perfect candidate to trigger rhabdomyolysis. In addition, participants could train harder with WB-EMS since the intervention is only limited by the extrinsic stimulus and not by the own ability to provide the necessary power and fitness.…”

Section: Introductionmentioning

confidence: 99%

<p>Safety of a Combined WB-EMS and High-Protein Diet Intervention in Sarcopenic Obese Elderly Men</p>

Kemmler

Stengel

Kohl

et al. 2020

CIA

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Purpose: Whole-body electromyostimulation (WB-EMS) especially in combination with a high-protein supplementation has been established as an efficient treatment against sarcopenia. However, there are several case reports of rhabdomyolysis after WB-EMS application. Thus, we asked if this training could potentially lead to deteriorations of the cardiac as well as the renal function. Materials and Methods: One hundred sarcopenic obese men aged 70 years and older were randomly balanced (1-1-1) and allocated to one of the three study arms. During 16 weeks of intervention, these groups either performed WB-EMS and took a protein supplement (WB-EMS&P), solely received the protein supplement (Protein) or served as control group (CG). WB-EMS consisted of 1.5×20 min (85 Hz, 350 μs, 4 s of strain to 4 s of rest) applied with moderate-to-high intensity while moving. We further generated a daily protein intake of 1.7-1.8 g/kg/body mass per day. At baseline and 8-10 days after completion of the intervention, blood was drawn and biomarkers of muscle, cardiac and renal health were assessed. Results: Hereby, we found slight but significant elevations of creatine kinase (CK) levels in the WB-EMS group pointing to minor damages of the skeletal muscle (140 U/l [81-210], p < 0.001). This was accompanied by a significant, low-grade increase of creatine kinase-muscle brain (CK-MB, 0.43 ng/mL [−0.29-0.96], p < 0.01) and high-sensitivity troponin T (hsTnT, 0.001 ng/mL. [0.000-0.003], p < 0.001) but without a higher risk of developing heart failure according to N-terminal prohormone of brain natriuretic peptide (NT-proBNP, −5.7 pg/mL [−38.8-24.6], p = 0.17). Estimated glomerular filtration rate (eGFR) was impaired neither by the high-protein supplementation alone nor in combination with WB-EMS (CG 76.0 mL/ min/1.73 m 2 [71.9-82.2] vs Protein 73.2 mL/min/1.73 m 2 [63.0-78.9] vs WB-EMS&P 74.6 mL/min/1.73 m 2 [62.8-84.1], p = 0.478). Conclusion: In conclusion, even in the vulnerable group of sarcopenic obese seniors, the combination of WB-EMS with a high-protein intake revealed no short-term, negative impact on the eGFR, but potential consequences for the cardiovascular system need to be addressed in future studies.

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Exertional rhabdomyolysis in a 21-year-old healthy man resulting from lower extremity training

Cited by 8 publications

References 30 publications

Causes and outcome of rhabdomyolysis in patients admitted to medical wards in the Prince of Wales Hospital

Causes and outcome of rhabdomyolysis in patients admitted to medical wards in the Prince of Wales Hospital

CrossFit-Induced Rhabdomyolysis in a Young Healthy Indonesian Male

<p>Safety of a Combined WB-EMS and High-Protein Diet Intervention in Sarcopenic Obese Elderly Men</p>

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