Exercise-Induced Rhabdomyolysis

doi:10.1016/S0196-0644(94)70356-6

Annals of Emergency Medicine

Volume 23, Issue 6, June 1994, Pages 1301-1306

Presented at the Society for Academic Emergency Annual Meeting, San Francisco, California, May 1993.

https://doi.org/10.1016/S0196-0644(94)70356-6 Get rights and content

Abstract

Study objective: To describe the syndrome of exercise-induced rhabdomyolysis and to investigate the relation between exercise-induced rhabdomyolysis and the development of acute renal failure. Design: Retrospective chart analysis on all patients with a discharge diagnosis of rhabdomyolysis from January 1988 to January 1993. Setting: An urban tertiary care center with 225,000 annual emergency department visits. Type of participants: Thirty-five patients met the inclusion criteria for exercise-induced rhabdomyolysis: a history of strenuous exercise, creatine phosphokinase level more than 500, and urine dipstick positive for blood without hematuria. We excluded patients with a history of trauma, myocardial infarction, stroke, or documented sepsis. Charts also were examined for the presence of nephrotoxic cofactors (ie, hypovolemia and/or acidosis). Results: All 35 patients were men without significant past medical history and were an average age of 24.4 years. The average admission creatine phosphokinase was 40,471 U/L. No patient presented with or developed nephrotoxic cofactors during hospitalization. None of our study patients experienced acute renal failure. Conclusion: Previous literature has described a 17% to 40% incidence of acute renal failure in rhabdomyolysis. None of our patients developed acute renal failure, signifying a much lower incidence of acute renal failure in exercise-induced rhabdomyolysis without nephrotoxic cofactors than in other forms of rhabdomyolysis.

[Sinert R, Kohl L, Rainone T, Scalea T: Exercise-induced rhabdomyolysis. Ann Emerg Med June 1994;23:1301-1306.]

Section snippets

INTRODUCTION

Since the original description of the syndrome of muscle pain, weakness, and brown urine by Meyer-Betz in 1910,¹ numerous case reports have linked rhabdomyolysis to such strenuous activities as military basic training2, 3 and weight lifting.⁴ Knochel⁵ has termed exercise-induced rhabdomyolysis "white collar rhabdomyolysis" because of its high incidence in intelligent, well-educated professionals who can arrange their work schedules to allow for daily running. Although training probably

MATERIALS AND METHODS

This study was designed as a retrospective cohort analysis of all cases of exercise-induced rhabdomyolysis. Medical records were reviewed for a five-year period (January 1988 to January 1993) using a computer search of the ICD-9 code (728.89) for both the primary and secondary discharge diagnoses of rhabdomyolysis. The study inclusion criteria for exercise-induced rhabdomyolysis were an elevated CPK concentration of more than 500 U/L (normal, 150 U/L or less), myoglobinuria, and a history of

RESULTS

The study population consisted of 35 male patients with an average age of 24.4 ± 5.4 years. Nineteen patients were black, 15 were Hispanic, and one was white. All patients were imprisoned at Rykers Correctional Institution at the time of admission.

Past medical history did not disclose previous episodes of rhabdomyolysis in any of the patients. No patient described similar histories of muscle weakness from exercise or family members with any muscle problems. Although nine patients gave a history

DISCUSSION

The clinical significance of rhabdomyolysis lies in its association with myoglobinuric acute renal failure and its subsequent mineral and electrolyte derangements. The 35 cases reported in this study are unique not only for their similarity in presentation but also for their lack of acute renal failure.

The incidence of acute renal failure secondary to rhabdomyolysis from all causes has been investigated. Studies by Ward,¹³ Gabow et al,¹⁴ and Kageyama¹⁵ found the incidence of

CONCLUSION

Rhabdomyolysis is a relatively common complication of strenuous exercise, as evidenced by the military recruit data⁸ and the large number of reports of "white collar rhabdomyolysis" gathered by Knochel.⁵ Reports of exercise-induced rhabdomyolysis in professional athletes6, 7 support our experience that neither the amount of exercise nor the level of training appears to be a reliable predictor for the development of rhabdomyolysis.

Exercise-induced rhabdomyolysis accounted for 47% of our

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To evaluate the occurrence of renal injury in hospitalized patients with the diagnosis of rhabdomyolysis among a series of patients presenting to an urban emergency department.
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^☆: From the Department of Emergency Medicine, State University of New York Health Science Center at Brooklyn/Kings County Hospital Center, Brooklyn, New York.

^☆☆: Address for reprints: Richard Sinert, DO, Department of Emergency Medicine, State University of New York Health Science Center at Brooklyn/Kings, County Hospital, Box 1228, 450 Clarkson Ave, Brooklyn, New York 11203, 718-245-4795, Fax 718-245-4799

^★: Reprint no. 47/1/56030

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Exercise-Induced Rhabdomyolysis☆,☆☆,★

Abstract

Section snippets

INTRODUCTION

MATERIALS AND METHODS

RESULTS

DISCUSSION

CONCLUSION

Beobachtugen an einem eigenartigen mit muskellahmungen verbundenen Fall von Hamoglobinurie

Dtsch Arch Klin Med

Exertional rhabdomyolysis and acute renal failure following the Army Physical Fitness Test

Mil Med

Exercise myoglobinemia and acute exertional rhabdomyolysis

Arch Intern Med

Severe rhabdomyolysis in well conditioned athletes

Mil Med

Catastrophic medical events with exhaustive exercise: "White collar rhabdomyolysis."

Kidney Int

Myoglobinuria, rhabdomyolysis and marathon running

Q J Med

Studies on myoglobinuria

Tohoku J Exp Med

Incidence of acute exertional rhabdomyolysis

Arch Intern Med

Crush injuries with impairment of renal function

BMJ

The production of renal failure following injection of solutions containing myohaemoglobin

Q J Exp Physiol

Nephrotoxicity of myoglobin in the rat: Relative importance of urine pH and prior dehydration (abstract)

Kidney Int

Uraemia in the rabbit after injection of crystalline myoglobin

Br J Exp Pathol

Factors predictive of acute renal failure in rhabdomyolysis

Arch Intern Med

The spectrum of rhabdomyolysis

Medicine