⭐⭐⭐⭐⭐ Rhabdomyolysis Case Study

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Rhabdomyolysis Case Study



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Approach to the patient with rhabdomyolysis

Advanced Search. Privacy Copyright. Abstract Objective : To present the case of recurrent rhabdomyolysis in an active female Background : A healthy 21 year old female developed severe fatigue and peripheral edema in the upper extremities after an extreme exercise workout session. Included in Sports Sciences Commons. Select an issue: All Issues Vol. The second major symptom is pain in the affected muscles caused by the inflammatory chemicals. After you have seen a few of these patients, you can pick them out by their gait alone! There are two main blood tests that can confirm the diagnosis and help you determine how serious this particular case is.

The first is creatinine phosphokinase CPK , which is an enzyme found inside muscle cells. Like myoglobin, CPK is released into the blood when muscle cells rupture. You can to some extent gauge the amount of muscle damage by how high the CPK climbs. Rhabdomyolysis can be diagnosed by a CPK 5 times greater than normal but may exceed , in severe cases. BUN and creatinine, the kidney function tests, are also critical to obtain to determine if the rhabdomyolysis is severe enough to cause renal impairment.

There are several other tests that may help in particular cases, such as urine myoglobin, electrolytes and CO2 for acidosis. Treatment for rhabdomyolysis is to clear the myogobin. In most cases, this can be done by aggressively hydrating the patient, either orally or with IV fluids, which gives the kidneys the water they need to flush the myoglobin without its solidifying in the renal tubules. In bad cases with very high CPK levels and kidney failure, hemodialysis may be needed. Several things can cause rhabdomyolysis, but these are the Big Three: Overexertion, crush trauma, and drugs. I have seen all three in my jails. Most cases of rhabdomyolysis in correctional facilities are caused by over-exertion. There is the guy who thinks he can squat as much weight as he did in high school ten years ago.

Usually, these are not too serious if the patients come to the medical clinic right away so we can hydrate them. My first case is a patient who did lots of heavy squats four days previously. He walked like a stork and had almost black urine. His initial CPK was over , and his initial BUN and creatinine were slightly elevated, indicating that he already had renal involvement by the time we first saw him.

We treated him with two cycles of two liter IV hydration, then rechecked his labs. His kidney function had actually worsened a little bit. So we sent him to the hospital where he underwent two days of hemodialysis. He did eventually recover, a little wiser, I hope. This case emphasizes the importance of early and aggressive hydration. Rhabdomyolysis can be caused by drugs, as well as overexertion. The major culprits are the statins, antipsychotics and serotonin agents like the SSRIs.

Counting this case, at least 15 college football players with SCT have died from complications of exertional sickling, as have younger football players and other athletes. In SCT, maximal, sustained exercise evokes four forces that can foster sickling: hypoxemia, acidosis, hyperthermia, and red cell dehydration. The setting, the clinical and laboratory features, and the clinicopathological correlation here suggest that the fulminant rhabdomyolysis and its fatal sequelae were from exertional sickling. These data suggest that screening and simple precautions for SCT may be warranted to prevent tragedies like this and enable all athletes with SCT to thrive in their sports.

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