Exertional Rhabdomyolysis-When Should We Start Worrying?

Abstract

Exertional rhabdomyolysis (ER) is a serious medical issue usually seen in individuals or patients after engaging in heavy exertion and physical activity. The incidence, natural course, and recurrence of ER are, by and large, unknown. Given the lack of rigorous scientific data that are specific for ER, most of the patients with ER receive treatment in an inpatient setting even with only a mild elevation of creatine phosphokinase (CPK) level. Often, patients receive inpatient treatment solely on the basis of elevated CPK (<3000 IU) even in the absence of other serious signs and symptoms of ER. We intent to describe 2 case reports that involve patients who developed ER after an intense physical exertion and were managed in an outpatient setting with close follow-up. In the discussion part, we point suggest that in patients with a relatively mild CPK elevation (<15,000 IU) and normal creatinine value and in the absence of factors such as profound dehydration, sickle cell trait, concomitant infectious cause, underlying metabolic syndrome, and current and ongoing use of analgesics, the complications after ER are low. Patients who develop ER, who can be reliably followed up, and who fulfills these criteria can be managed as outpatients.

How to exhaust your bone marrow

“…Excessive physical stress is known to cause varying degrees of organ damage 2. The resulting overtraining syndrome (OTS)3 is a well-described phenomenon with neurological, endocrinological, immunological and psychological symptoms.…”

Visits of patients with exertional rhabdomyolysis to the Emergency Department at Landspítali, The National University of Iceland in the years 2008-2012

“…4,14 Talið er að ef CK-haekkun í sermi er minni en 15.000 IU/L, kreatíníngildi eðlilegt og ekki er um ofþornun að raeða, megi flokka rákvöðvarofið sem góðkynja og er þá ekki þörf á sérstakri meðferð. Ef CK-haekkun er 15 Vökvagjöfin eykur rúmmál utanfrumuvökva sem minnkar við rákvöðvarof og minnkar sömuleiðis styrk vöðvarauðans í nýrungum og dregur þannig úr líkum á bráðum nýrnaskaða. 6 Faraldsfraeði rákvöðvarofs í almennu þýði eftir líkamlega áreynslu virðist ekki hafa verið rannsökuð á Íslandi né annars staðar.…”

“…15 Þá er mikilvaegt að gefa ríkulega vökva í aeð til að fyrirbyggja bráðan nýrnaskaða. Niðurstöður okkar benda til þess að þeir sem fá vökva í aeð sem meðferð við áreynslurákvöðvarofi séu almennt með mun haerri CK-gildi en aðrir.…”

Evaluation of heat stress, heat strain, and rhabdomyolysis during structural fire fighter training.

“…The severity of rhabdomyolysis depends upon damage to other organ systems and the peak CK level. Mild rhabdomyolysis can be treated by drinking lots of fluids [George et al 2010]. Severe cases require hospitalization to provide fluids intravenously, monitor CK levels to guide treatment, and follow kidney function as emergent dialysis may be needed if the kidneys fail.…”