Exertional rhabdomyolysis in newly enrolled cadets of a military academy

Abstract

Introduction/Aims: Exertional rhabdomyolysis (ER) often occurs during prolonged intense exercise in hot environments, posing a threat to the health of military personnel. In this study we aimed to investigate possible risk factors for ER and provide further empirical data for prevention and clinical treatment strategies.Methods: A retrospective investigation of 116 concurrent ER cases was conducted.Conditional logistic regression analyses were performed to assess the association between each potential risk (or protective) factor and ER. The clinical characteristics of the 71 hospitalized patients were analyzed descriptively.Results: After screening, the following variables significantly increased the risk of ER: shorter length of service (recruits; odds ratios [OR], 7.49; 95% confidence interval [CI], 2.58-21.75); higher body mass index (BMI; OR, 1.14, 95% CI, 1.03-1.26); lack of physical exercise in the last half year (less than once per month; OR, 3.20; 95% CI, 1.08-9.44); and previous heat injury (OR, 2.94; 95% CI, 1.26-6.89). Frequent fruit consumption (OR, 0.57; 95% CI, 0.33-0.99), active hydration habit (OR, 0.37; 95% CI, 0.20-0.67), water replenishment of more than 2 L on the training day (OR, 0.15; 95% CI, 0.05-0.45), and water replenishment of at least 500 mL within 1 hour before training (OR, 0.33; 95% CI, 0.12-0.88) significantly decreased the risk of ER. Of the 71 hospitalized patients, 41 (57.7%) were diagnosed with hypokalemia on admission.Discussion: In military training, emphasis should be placed on incremental adaptation training before more intense training, and close attention should be given to overweight and previously sedentary recruits. Fluid replenishment before exercise, increased fruit intake, and proper potassium supplementation may help prevent ER.

Foot drop secondary to rhabdomyolysis: improved foot dorsiflexion and gait after neurolysis and distal nerve transfer—a case series and literature review

“…The incidence of gait impairment and foot drop in RML patients is low, about 0.4%. Most of these patients recovered from RML after hemodialysis for acute kidney injury or renal failure but developed permanent foot drop [ 4–10 , 13 , 17 , 19 , 20 , 23–30 ]. There was no report on these patients who were discharged with permanent foot drop if they had surgery for foot drop.…”

“…The etiology of RML can be a traumatic or non-traumatic muscle injury. The common causes of RML are trauma [ 18 ], strenuous exercise [ 11 , 19–23 ], exertion [ 9 , 21 , 23 ], infections [ 2 ], metabolic and electrolyte disorders [ 2 ], muscle compression [ 24 ], tourniquet [ 25 ], immobilization [ 12 , 26 ], hypothyroidism [ 27–29 ], drugs, specifically lipid-lowering drug statin [ 27–29 ], toxins [ 7 ], drug overdose [ 4 , 30 , 31 ], enzyme deficiency [ 32 ], and genetic defects [ 33 , 34 ].…”

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

“…Among 28 included articles [15][16][17][18][19][20]22,23,[25][26][27][29][30][31][32][33][34][35][36][37][38][39][40][41][43][44][45][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][33][34][35][37][38][39][40][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][30][31][32][33]36,37,39,40,[43][44][45][46], it was checked during patients' hospital stay in six of them [17,18,23,25,27,…”

Sportomics suggests that albuminuria is a sensitive biomarker of hydration in cross combat

“…Adequate hydration is a central biological issue, and inadequate fluid intake associated with intensive exercise programs has been associated with harmful conditions, such as rhabdomyolysis and the impairment of renal filtration 14 , 15 . The first reports of rhabdomyolysis in the modern era occurred during World War II, and some biblical references are related to the disease (for a review, refer to Zager 16 ), and hydration can both prevent and treat this condition 17 , 18 . The evaluation of nitrogenous compounds such as creatinine, urea, and urate is of great value in daily clinical follow-up; however, the elevation of these parameters in the blood is already a consequence of the impairment of renal filtration.…”