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Acute Exertional Rhabdomyolysis


Presentation

  • The physician should maintain a high index of suspicion for acute exertional rhabdomyolysis in patients who present with symptoms of an overexertion injury, most commonly pain and swelling in the affected muscles.[ncbi.nlm.nih.gov]
  • It was considered that aggresive exercise performed under hot environment led to acute rhabdomyolysis and subsequent acute renal failure in the present case.[jstage.jst.go.jp]
  • The following case report demonstrates the subtle presentation this disease may have. ILLUSTRATIVE CASE A 24-year-old man presented to the clinic with a history of pain and bilateral swelling of the arms and chest.[drplace.com]
  • Exercise-related muscle pain, elevated serum creatine kinase (CK), and "cola-colored" urine have been described as a classic presentation of ER. The exact mechanism of ER has not been clearly elucidated.[ncbi.nlm.nih.gov]
  • Goldman-Cecil Medicine offers definitive, unbiased guidance on the evaluation and management of every medical condition, presented by a veritable "Who's Who" of modern medicine.[books.google.com]
Physician
  • The physician should maintain a high index of suspicion for acute exertional rhabdomyolysis in patients who present with symptoms of an overexertion injury, most commonly pain and swelling in the affected muscles.[ncbi.nlm.nih.gov]
  • Am Fam Physician. 1995;52:502–6.[acronymattic.com]
  • Home - Family Physician Author: Robin L. Line, George S.[drplace.com]
  • Goldman-Cecil Medicine is an ideal learning tool for residents, physicians, and students as well as a valuable go-to resource for experienced healthcare professionals.[books.google.com]
  • OPHD held phone or in-person interviews with selected physicians involved in care of the team members, including the two orthopedists who performed the operations and the hospitalist/football team physician involved in the inpatient management of many[cappaa.com]
Fever
  • Paracetamol, also known as acetaminophen or apap, is a medicine used to treat pain tylenol for fever with stomach virus flu side effects" tylenol cold and flu side effects and fever. Hyldahl, Justin Keadle, Pierre.[vnezapil.com]
  • Continued Other common signs of rhabdomyolysis include: Abdominal pain Nausea or vomiting Fever, rapid heart rate Confusion, dehydration, fever, or lack of consciousness Blood tests for creatine kinase, a product of muscle breakdown, and urine tests for[webmd.com]
  • He was found to be normotensive, without fever, presenting serious oedemas in lower limbs and with oliguria.[revistanefrologia.com]
  • In addition, fever, fasting and stress can induce symptoms. Symptoms are not triggered by isometric contraction in people with fatty acid metabolism dysfunction.[ojrd.biomedcentral.com]
  • Constitutional symptoms vary on the cause; the most common are generalised malaise, fever and nausea. The associated electrolyte disturbance can lead to agitation and confusion.[patient.info]
Military Personnel
  • Another report in 1960 cited 60 marine recruits who sought medical attention during a period of one year because of pigmenturia and muscle pain associated with exertion.(4) Awareness of this syndrome among military personnel increased in 1971 when 40[drplace.com]
  • A number of high-profile deaths among athletes and military personnel involving exertional rhabdomyolysis have been attributed to sickle cell trait. The National Collegiate Athletic Association, the U.S. Air Force, and the U.S.[mdedge.com]
  • These problems have been recognized among military personnel, long-distance runners, and other athletes (2-6). However, exercise-related rhabdomyolysis and renal impairment have not been previously described in the groups involved in this report.[cappaa.com]
  • Exertional rhabdomyolysis is well described among athletes and military personnel, but may occur in anybody exposed to unaccustomed exercise.[bmjopensem.bmj.com]
  • This syndrome has received considerable attention because of high-profile deaths involving exertional rhabdomyolysis in athletes and military personnel. 1-10 A number of such cases have been attributed to sickle cell trait, 11-15 a condition in which[nejm.org]
Severe Pain
  • He was evaluated by an orthopaedic surgeon for a chief complaint of severe pain in both lower extremities that began 2 days prior after performing repetitive, vigorous squatting exercises.[ncbi.nlm.nih.gov]
  • He ran in a marathon on a warm day (85[degrees]F [29[degrees]C]), and after nine miles he collapsed, experiencing severe pain in his calves and thighs.[drplace.com]
  • In combination with opioid pain medication, paracetamol is also used for severe pain such. 1986 - PubMed result.gov/pubmed/3511134# A cyclooxygenase-2 tylenol flu nighttime side effects inhibitor impairs ligament heal.[vnezapil.com]
Recent Viral Illness
  • viral illness.(9) Occupational, recreational, environmental and medical risk factors are listed in Table 1.[drplace.com]
Myopathy
  • The rare cases of acute renal failure in marathon runners may be a situation of the ‘perfect storm’ where there are several factors (heat stress, dehydration, latent myopathy, non-steroidal anti-inflammatory or other drug/analgesic use, and viral/bacterial[link.springer.com]
  • Minicore (multicore) myopathy Minicore (multicore) myopathy Minicore myopathy, also called, multicore myopathy and multiminicore myopathy, falls under the umbrella of congenital myopathies.[docplayer.net]
  • Called also azoturia, Monday morning disease, tying up syndrome, capture myopathy. rhabdomyolysis disintegration of striated muscle fibers with excretion of myoglobin in the urine. exertional rhabdomyolysis transient exertional rhabdomyolysis[medical-dictionary.thefreedictionary.com]
  • Recessive mutations in ANO5 (OMIM#608662) cause a wide spectrum of myopathies including LGMD2L, distal myopathy and isolated hyperCKemia.[ojrd.biomedcentral.com]
  • However, the results of myopathological changes and tandem mass spectrometry were not consistent with ischemic myopathy.[zdoc.site]
Myalgia
  • Results: Among 43 players, 22 (51%) experienced rhabdomyolysis (peak creatine kinase range, 2434-42 000 U/L): 22 patients had upper arm myalgia; 12 were hospitalized; 3 experienced triceps compartment syndrome; none experienced renal failure.[stacks.cdc.gov]
  • The myalgia improved progressively until it disappeared.[revistanefrologia.com]
  • A 62-year-old man was brought to the hospital with back pain and muscle weakness accompanied by myalgia. These symptoms developed 20 h after he had consumed his last meal which included the wild mushroom Russula subnigricans.[blog.goo.ne.jp]
  • RM and myalgia may be the dominating symptom in a few cases of LGMD2I [ 82 ].[ojrd.biomedcentral.com]
  • There was no correlation whatsoever between CK levels and the amount of exertion, environmental conditions, or myalgia, or weakness.[bmjopensem.bmj.com]
Muscle Weakness
  • The muscle weakness persisted for over a week. The maximal serum creatine kinase activity was 42,689 U/L.[blog.goo.ne.jp]
  • Two patients who demonstrated increased muscle mass, muscle stiffness with variable degrees of muscle weakness and low levels of serum thyroxine (Hoffmann's syndrome) are described.[scinapse.io]
  • The “classic triad” of rhabdomyolysis symptoms are: muscle pain in the shoulders, thighs, or lower back; muscle weakness or trouble moving arms and legs; and dark red or brown urine or decreased urination.[webmd.com]
  • Patients with McArdle’s disease present intolerance to shortterm exercise and cramps or muscle weakness especially as in the case of our patient when he was subjected to short and frequent periods of physical exercise through the use of an electrostimulator[revistanefrologia.com]
  • […] vacuoles on muscle biopsy, unstable serum CK levels NM transmission disorder Affects women more, usually in 20-30s Affects men in 50-60s relatively common Decrease Ach receptors in postsynaptic membrane, antiAChR antibodies fatiguable weakness of SK muscle[quizlet.com]
Muscle Swelling
  • Albumin is rarely indicated for the treatment of hypoalbuminemia since it may leak into the interstitial space and cause muscle swelling to worsen.[drplace.com]
  • However, people experiencing AER usually present with a triad of symptoms including: severe muscle soreness, significant muscle swelling, and cola-colored urine.[columbusgeorgiaonline.com]
  • His muscle swelling subsided on day 6. His creatinine gradually dropped to 2.8 mg/dL on 8 th day. He was shifted to ward on the 7 th day. The IV infusions were stopped. He received at least 3 L of oral fluids and rest in the ward.[mjdrdypu.org]
  • Of the 43 football players participating in the camp, three needed surgery for compartment syndrome, a type of painful muscle swelling.[cappaa.com]
  • swelling and/or neurological disturbances. keygen thinkchange mazelock east palo alto crack crack do ets 2 wersja 1.3.1 Crush Syndrome: Crush injury with systemic manifestations.[sordtss.ga]
Muscle Swelling
  • Albumin is rarely indicated for the treatment of hypoalbuminemia since it may leak into the interstitial space and cause muscle swelling to worsen.[drplace.com]
  • However, people experiencing AER usually present with a triad of symptoms including: severe muscle soreness, significant muscle swelling, and cola-colored urine.[columbusgeorgiaonline.com]
  • His muscle swelling subsided on day 6. His creatinine gradually dropped to 2.8 mg/dL on 8 th day. He was shifted to ward on the 7 th day. The IV infusions were stopped. He received at least 3 L of oral fluids and rest in the ward.[mjdrdypu.org]
  • Of the 43 football players participating in the camp, three needed surgery for compartment syndrome, a type of painful muscle swelling.[cappaa.com]
  • swelling and/or neurological disturbances. keygen thinkchange mazelock east palo alto crack crack do ets 2 wersja 1.3.1 Crush Syndrome: Crush injury with systemic manifestations.[sordtss.ga]
Suggestibility
  • This observation suggests that rhabdomyolysis in hypothyroidism may be due to a reversible defect in glycogenolysis and that hypothyroidism should be excluded in patients with rhabdomyolysis and/or myoglobinuria.[ncbi.nlm.nih.gov]
  • Recent reports suggest that acute exertional rhabdomyolysis is more common and more serious than previously realized. Mild to moderate acute exertional rhabdomyolysis can result in hyperkalemia, hypernatremia, lactic acidosis and hyperphosphatemia.[ncbi.nlm.nih.gov]
  • Most studies suggest a cascade of events that include depletion of adenosine triphosphate (ATP), impaired function of the Na - K ATPase system, intracellular excess calcium accumulation, sarcolemma damage, and release of intracellular proteins and other[ncbi.nlm.nih.gov]
  • The increasing risk also suggests that the preventive measures could have been inadequate.[cappaa.com]
  • Data from the military suggest that prolonged lower intensity training reduces the risk for acute exertional rhabdomyolysis, compared with more intense exercise over a shorter period of time.[drplace.com]
Dark Urine
  • CASE 1 A 30-year-old man, who at the age of 14 suffered from episodes of acute myalgia and from dark urine due to prolonged physical exercise (walking 6-7 kilometres.) No family member showed similar episodes.[revistanefrologia.com]
  • Any manipulation in diet should be monitored with lower intensity exercise first to make sure the athlete responds well before exposing them to strenuous exercise. • If your athlete reports dark urine a day or two after an exercise session report them[bsmpg.com]
  • In 1988, for example, all 50 participants in a law enforcement training class demonstrated laboratory evidence of rhabdomyolysis (CK level greater than 10 times normal), and 13 patients were admitted to the hospital with clinical complaints of dark urine[drplace.com]
  • They should alert coaches or athletic trainers if they develop any of the signs, such as muscle pain and swelling and dark urine. If there is a question, they should go to a hospital emergency department for evaluation and possible treatment.[drdavidgeier.com]
Red Urine
  • . - By the way, the answer to the above question is muscle pain, weakness, and brown/red urine.[pictaramci.com]
  • Diagnostic testing should be performed in patients who present with: The combination of muscle soreness and pigmenturia (specifically, dark brown or red urine) Either muscle soreness OR pigmenturia who have a recent history positive for any of the potential[emdocs.net]

Workup

  • A minimallaboratory workup in rhabdomyolysisincludes serum levels o CK, calcium,electrolyte renal unctions, in conjunc-tion with detection o myoglobin inurine and an electrocardiogram.[usdocument.net]
  • Note that depending on clinical picture, further workup regarding each of the following potential complications may be warranted. For example, neuroimaging is not generally performed in the setting of EHS.[emdocs.net]
  • […] in significantly higher frequencies in patients who presented with severe episodes of ERM. 60 However, in the reported study, the authors did not specify the other genetic causes of rhabdomyolysis that had been investigated as part of the diagnostic workup[bmjopensem.bmj.com]
  • Magnetic resonance imaging (MRI; assessment of myopathy) Other tests that may be considered include the following: Electrocardiography (ECG) Measurement of compartment pressures Muscle biopsy Immunoblotting, immunofluorescence, and genetic studies See Workup[emedicine.medscape.com]
Candida
  • […] species Salmonella species [14] Listeria species Legionella species [25] Mycoplasma species [26] Vibrio species Brucella species Bacillus species Leptospira species [27] Fungal infectious agents that may cause rhabdomyolysis include the following [18] : Candida[emedicine.medscape.com]

Treatment

  • A 28-year-old man on thyroid hormone replacement following treatment with radioactive iodine for Graves' disease developed an episode of acute exertional rhabdomyolysis.[ncbi.nlm.nih.gov]
  • Practical, bulleted, highly templated text with easy-to-use features including flow charts and treatment boxes.[books.google.com]
  • Albumin is rarely indicated for the treatment of hypoalbuminemia since it may leak into the interstitial space and cause muscle swelling to worsen.[drplace.com]
  • Cessation of physical activity, relative rest during clinical recovery, and early aggressive fluid replacement are mainstays of treatment.[ncbi.nlm.nih.gov]
  • Treatment included intravenous hydration with sodium bicarbonate to reduce myoglobin, blood work to monitor CK levels, and acupuncture from the shoulder to hand. Three weeks posttreatment, the subject started to exercise again.[journals.lww.com]

Prognosis

  • Regardless, research agrees that with prompt diagnosis and medical intervention, the prognosis for full recovery after suffering from AER is good, making it is essential for all health professionals to be able to recognize signs and symptoms of AER and[columbusgeorgiaonline.com]
  • , Taiwan (3) Renal Division, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, No.168, Jhongsing Road, Longtan Township, Taoyuan County, 32551, Taiwan References Imazio M, Trinchero R: Myopericarditis: etiology, management, and prognosis[bmcinfectdis.biomedcentral.com]
  • The ability to identify these patient early in the course of a rhabdomyolysis episode is useful for early institution of aggressive prophylactic measures, admission to the ward or intensive care unit, and communication with patients and families about prognosis[bmjopensem.bmj.com]
  • The prognosis in rhabdomyolysis is significantly worse if AKI is present [21]. While the data on mortality varies with cause of rhabdomyolysis and AKI, studies have shown that in all causes, AKI increases the likelihood of mortality.[emdocs.net]

Etiology

  • (top down), proximal in distribution patients can ambulate can have bulbar symptoms decreased DTR diagnosis- muscle biopsy (to rule out primary muscle), nerve conduction studies , genetic testing guillaine-barre syndrome -epidemiology -pathogenesis -etiology[quizlet.com]
  • The underlying etiology of this catastrophic presentation of adolescent diabetes mellitus is unclear.[emedicine.medscape.com]
  • Diagnosis With many etiological factors that may produce the onset of rhabdomyolysis, proper diagnosis is important in order to determine appropriate forms of treatment.[kon.org]
  • Table 1 Etiologies of viral myopericarditis Coxsackievirus * Parainfluenza Adenovirus Human immunodeficiency virus Cytomegalovirus Varicella Echovirus Mumps Influenza * Rubeola Epstein–Barr virus Rubella Herpesvirus Poliomyelitis Hepatitis virus Rhinovirus[bmcinfectdis.biomedcentral.com]
  • DISCUSSION In 1941 it was performed the first detailed description of rhabdomyolysis. 1 Since then, numerous cases report has been published and it has been known a growing list of possible etiologies 2 (table 1.)[revistanefrologia.com]

Epidemiology

  • Study Design: Descriptive epidemiology study.[stacks.cdc.gov]
  • In late July, an epidemiologic investigation was initiated; the investigation included an environ mental evaluation for carbon monoxide, which did not reveal elevated levels inside the building.[cappaa.com]
  • The family physician plays a critical preventive role in counseling patients who have environmental, recreational, occupational or medical risk factors for this potentially life-threatening illness.(3) Historical and Epidemiologic Perspectives Until 1960[drplace.com]
  • Epidemiologic aspects of the Bam earthquake in Iran: the nephrologic perspective. Am J Kidney Dis. 2006;47(3):428. Gunal AI, Celiker H, Dogukan A, Ozalp G, Kirciman E, Simsekli H, Gunay I, Demircin M, Belhan O, Yildirim MA, Sever MS.[gacetamedicaboliviana.com]
  • Epidemiology Incidence figures are not available for the general population, but screening of 337 military recruits for myoglobin serum levels, showed rhabdomyolysis in 40%. [ 6 ] It is more common in men, particularly well-educated professionals, who[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • This article reviews the definitions, pathophysiology, diagnosis, and management of ER with specific relevance to acute kidney injury.[ncbi.nlm.nih.gov]
  • Pathophysiology of ERM Reports of RM date back thousands of years (Vanholder et al. 2000).[ideafit.com]
  • Pathophysiology Rhabdomyolysis occurs when the integrity of the skeletal muscle membrane is violated, causing CK-MM, aldolase and myoglobin to leak into the circulation at the time of injury.[drplace.com]
  • Research Educational research and school practice Culture and Cultural Practice Lived Religion and Religious Practice in Ever General Pathology and Clinical Medicine Pharmacology and Clinical pharmacy Yoruba and Ifa practice Physiology and clinical pathophysiology[allslide.net]
  • However, they may in fact be pathophysiologically related under certain circumstances.[bmcinfectdis.biomedcentral.com]

Prevention

  • Early intervention with aggressive hydration and close monitoring for metabolic, renal or hematologic complications may prevent serious injury or death.[ncbi.nlm.nih.gov]
  • In such cases, early fasciotomy may be necessary to prevent further necrosis and gangrene.(1) Treatment Early fluid replacement is the key to managing acute exertional rhabdomyolysis.[drplace.com]
  • Greater awareness of specific exercise hazards and prevention strategies can minimize risk for clinically significant muscle injury.[stacks.cdc.gov]
  • The increasing risk also suggests that the preventive measures could have been inadequate.[cappaa.com]
  • Although the possibility of someone having exertional rhabdomyolysis is low, it is best to be well-versed in the causes, the signs and symptoms, and what to do in order to prevent this from happening! Dr.[mp-body.com]

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