Diagnosis

Exertional Rhabdomyolysis

Rhabdomyolysis is the result of breakdown of striated muscle tissue. The damage to the muscle fibers causes a release of myoglobin, lactic acid, potassium, purines and other intracellular compounds. Normally myoglobin is filtered in the glomeruli and reabsorbed in the proximal tubules. In an acidic environment, such as seen when there is an infusion of lactic acid, myoglobin accumulates in the tubules and can produce obstructive kidney failure.  

While the most characteristic symptom is muscle pain, cramping, local swelling and tenderness, in a significant number of cases the presentation is vaguer. Due to the ensuing electrolyte imbalance the patient may present with fatigue, disorientation, dizziness, nausea, confusion and vomiting. A low grade fever is often present associated with the reactive inflammation. The combination of fatigue, nausea and fever may lead a patient to think they are having a, “summer cold.” In severe cases the presentation reflects the resultant kidney failure. Often the only salient indicator is the dark colored urine.

Rhabdomyolysis is most commonly associated with crush injuries producing extensive muscle damage. The disorder can also be the result of numerous intrinsic and extrinsic factors.

Physical exertion

Muscle ischemia

Temperature extremes

Drugs, toxins, venoms - cocaine, heroin, opioids, corticosteroids, statin drugs

Metabolic - diabetic ketoacidosis, hypokalemia, hypo or hypernatremia

Endocrine - Addison’s, hypothyroid

Genetic – myopathies, muscular dystrophies

Infections

Autoimmune diseases

In the case of our patient, the increase in the level of physical exertion in conjunction with suspected insufficient hydration lead to excessive muscle breakdown.

Question: What are you treatment recommendations?