Exertional rhabdomyolysis: Relevance of clinical and laboratory findings, and clues for investigation

Heytens, Karel; Ridder, Willem De; Bleecker, Jan De; Heytens, L.; Baets, Jonathan

doi:10.1177/0310057x19835830

Cited by 7 publications

(3 citation statements)

References 19 publications

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“…We hypothesise that while higher CK levels are a key element for prolonged hospital stay, the rhabdo-heat group may have had other factors (ie, multiorgan system involvement) that contributed to longer LOS. Our research adds evidence that exertional rhabdomyolysis without associated medical comorbidities or EHI is a more benign, physiological process with a favourable prognosis as some authorities have suggested 20–23…”

Section: Discussionsupporting

confidence: 63%

Exertional rhabdomyolysis: an analysis of 321 hospitalised US military service members and its relationship with heat illness

Bury

McClure³

2022

BMJ Mil Health

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IntroductionExertional rhabdomyolysis is a syndrome of muscle breakdown following exercise. This study describes laboratory and demographic trends of service members hospitalised for exertional rhabdomyolysis and examines the relationships with heat illness.MethodsWe queried the US Armed Forces Health Surveillance Center’s Defence Medical Epidemiology Database for hospitalised cases of rhabdomyolysis associated with physical exertion from January 2010 July 2013. Descriptive statistics reported means and medians of initial, peak and minimal levels of creatine kinase (CK). Correlations explored the relationship between CK, creatinine, length of hospital stay (LOS) and demographic data.ResultsWe analysed 321 hospitalised cases of exertional rhabdomyolysis. 193 (60.1%) cases were associated with heat; 104 (32.4%) were not associated with heat; and 24 (7.5%) were classified as medical-associated exertional rhabdomyolysis. Initial, maximum and minimal CK levels were significantly lower in heat cases: CK=6528 U/L vs 19 247 U/L, p=0.001; 13 146 U/L vs 22 201 U/L, p=0.03; and 3618 U/L vs 10 321 U/L, p=0.023) respectively, compared with cases of rhabdomyolysis with exertion alone. Median LOS was 2 days (range=0–25). In the rhabdomyolysis with exertion alone group and the rhabdomyolysis with heat group, LOS was moderately correlated with maximal CK (Spearman’s ρ=0.52, p<0.001, and Spearman ρ=0.38, p<0.001, respectively). There was no significant difference in median LOS between the rhabdomyolysis with exertion alone and rhabdomyolysis associated with heat groups (2 vs 2, p value=0.96).ConclusionMost hospitalisations for exertional rhabdomyolysis were associated with heat illness and presented with lower CK levels than cases without associated heat illness. These data add evidence that rhabdomyolysis with heat illness is a different entity than rhabdomyolysis with exertion alone. Differentiating exertional rhabdomyolysis with and without heat should inform future research on rhabdomyolysis prognosis and clinical management.

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Section: Discussionsupporting

confidence: 63%

Exertional rhabdomyolysis: an analysis of 321 hospitalised US military service members and its relationship with heat illness

Bury

McClure³

2022

BMJ Mil Health

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“…Recently, more studies indicate that the prevalence of RM in black race is higher than that within the white race, because blacks are more likely to have an autosomal dominant genetic disease, sickle cell disease, which was characterized as chronic hemolytic anemia [9]. The clinical manifestation varies widely depending on the extent and severity of muscle damage ranging from an asymptomatic increase in the serum levels of enzymes released from muscle cells, e.g., CK, LDH, AST, to worrisome conditions associated with severe intravascular volume depletion, metabolic acidosis, multiple electrolyte abnormalities (hyperkalemia, hyperphosphatemia, and hypocalcemia), and AKI [11]. AKI is one of the most serious complications with incidence and mortality of 13% -50% and 20% -50%, respectively [12].…”

Section: Discussionmentioning

confidence: 99%

Exertional Rhabdomyolysis Induced Acute Kidney Injury: A Case Report and Literature Review

Zhang

2024

CRCM

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Background: The exRML (exertional rhabdomyolysis) is a pathophysiologic condition of skeletal muscle cell damage and breakdown associated with high intensity or prolonged exercise, normal exercise under extreme circumstances, or sudden and excessive skeletal muscle contraction. It may manifest from the increase in CK (creatine kinase) or MYO (myoglobin), a protein that can cause life-threatening injury to the kidney (AKI, acute kidney injury), and may or may not be associated with myoglobinuria. Here, we presented a case of exRML with AKI, and then reviewed the related reports. Vigorous hydration, sodium bicarbonate and furosemide are key treatments. Aim: To examine an elderly patient with exRML induced AKI and the key treatment process. Case summary: A 61-year-old man left our hospital without permission after his admission and has been walking for almost 30 kms with no water and food intake, then was diagnosed exRML and exRML induced AKI with an obvious elevation of CK, MYO and decrease of eGFR (estimated glomerular filtration rate) after coming back, and was treated with vigorous hydration, loop diuresis, sodium bicarbonate, prostaglandin and Shenkang injection. After vigorous resuscitation, the patient's renal function, CK and MYO returned normal. Conclusions: The exRML can cause serious complications such as AKI and death. Delayed diagnosis can be critical; therefore, manner of time should be taken to achieve a favorable prognosis.

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“…Exercise-related rhabdomyolysis occurred in three patients in our study, with two developing AKI. In rare cases of severe or recurrent episodes of exertional rhabdomyolysis, this may be a manifestation of an underlying muscle disorder, and it is important to identify factors that predict the risk of increased morbidity and mortality (20). In a study of subjects enrolled in basic military training, exertional rhabdomyolysis was very uncommon with minimal risk of recurrence, and it was less likely to result in renal failure than other causes of rhabdomyolysis (21).…”

Section: Discussionmentioning

confidence: 99%

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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Exertional rhabdomyolysis: Relevance of clinical and laboratory findings, and clues for investigation

Cited by 7 publications

References 19 publications

Exertional rhabdomyolysis: an analysis of 321 hospitalised US military service members and its relationship with heat illness

Exertional rhabdomyolysis: an analysis of 321 hospitalised US military service members and its relationship with heat illness

Exertional Rhabdomyolysis Induced Acute Kidney Injury: A Case Report and Literature Review

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

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