Exercise-Induced Rhabdomyolysis Causing Acute Kidney Injury: A Potential Threat to Gym Lovers

Exertion induced rhabdomyolysis in both triceps muscles in a 36-year old woman: A case report

Rhabdomyolysis is a condition, often caused by strenuous exercise, which can lead to acute kidney injury, severe electrolyte imbalances, coagulopathies, compartment syndromes, and even have a fatal outcome in a few cases. Recognition and management of fluid and electrolyte abnormalities is one of the first steps of treatment and key to a good outcome. We report a case of a 36-year old woman who was referred to the ER by her general practitioner with severe muscle tenderness to the upper arms and highly elevated creatine kinase (CK) serum levels. Initial ultrasound imagery showed a patent venous system but demonstrated a moderate edematous infiltration of the muscle bellies of both m. triceps. Additional magnetic resonance imagery showed a hyperintense signal in T2 in both triceps' muscles. Given the clinical presentation, the MRI-findings were consistent with a form of exertion-induced rhabdomyolysis of both triceps' muscles. The patient was admitted for administration of IV-fluids to prevent acute kidney injury. Symptoms resolved in a few days and new magnetic resonance imagery showed a regression of the subcutaneous soft tissue infiltration. The aim of this paper is to raise awareness about this diagnosis. If overlooked, severe complications as mentioned above can occur.

Exercise-induced rhabdomyolysis manifestations and complications: a case report

Introduction

Rhabdomyolysis is a medical condition that results from damage to striated muscles that causes the release of their components into the bloodstream. Laboratory indications include high levels of creatinine kinase and myoglobin in the serum.

Importance

This case report emphasizes the importance of having professional trainers in gyms and training centers who respect trainees' limitations and physical capabilities and ensure that physical exercise programs are being conducted safely and effectively.

Case presentation

A 39-year-old female healthcare provider presented to the emergency department at a tertiary/quaternary hospital in Saudi Arabia, with progressive right arm pain, swelling, weakness, and dark urine 2 days after an unaccustomed heavy physical exercise session with her personal trainer following a long pause from physical training.

Clinical discussion

Levels of serum creatinine kinase, aspartate aminotransferase, and alanine transaminase were moderately elevated. There was no evidence of renal impairment, electrolyte disturbance, or coagulopathy. The patient was treated with analgesics, received hydration, and was discharged home under close observation and with a follow-up clinic visit scheduled to check for complications. Data were collected from the hospital's electronic medical records, including clinical notes and laboratory investigations.

Conclusion

Awareness campaigns need to be conducted to educate the public about healthy ways to exercise, such as gradually increasing the intensity of physical activity, warming up before exercising, cooling down after each workout, and staying hydrated. It is important that healthcare providers, trainees and trainers are able to recognize the signs of muscular injury following vigorous exercise in order to reduce the incidences of complications that could be deadly if they are not caught and managed early.