Clinical Review of Exertional Rhabdomyolysis
ER is often characterized by a triad of symptoms including 1) muscle pain, 2) muscle swelling, and 3) myoglobinuria.
Rhabdomyolysis is a common and potentially fatal condition encountered by athletic trainers, coaches, primary care physicians and sports medicine physicians. Benign, or physiological, Exertional Rhabdomyolysis (ER) may resemble delayed onset muscle soreness (DOMS) and becomes clinically significant when accompanied by other morphologies including severe muscle pain and swelling, and myoglobinuria.
5x upper limits of CK/CPK are often mentioned as being a conservative range for diagnosis, with no definitive pathological value for CK/CPK.
Healthcare providers should be aware that levels of 20x the upper limit may be seen in those performing repetitive and strenuous exercise(lee), with documented cases of CK/CPK laboratory values more than 130,000 IU/L to 244,000 IU/L in literature.”
Rhabdomyolysis and ER are associated with a variety of complications including metabolic acidosis, disseminated intravascular coagulation (DIC), hypocalcemia, hyperkalemia, arrythmias, compartment syndrome, acute renal failure, cardiac arrest, and even death.
CK/CPK is one of the most used biomarkers in the diagnosis of rhabdomyolysis though CK/CPK levels ranging from 5 times to 50 times upper normal limits have been proposed in the literature.
- Understand the physical demand and physiological responses resulting in exertional rhabdomyolysis
- Be able to identify the signs and symptoms of athletes exhibiting exertional rhabdomyolysis
- Understand the proper steps in the treatment for these athletes
- Understand a practitioner’s role in mitigating exertional rhabdomyolysis in an athletic population