Exertional Rhabdomyolysis

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Exertional Rhabdomyolysis

• An under-diagnosed killer!

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What is Rhabdomyolysis

• A by-product of intense exercise.
• Extreme physical exertion may/can trigger this
  disorder.
• Syndrome of injury to skeletal muscle that causes
  release of its contents into the extracellular
  fluid and plasma.
• Can be diagnosed by measurement of increased
  serum levels of muscle content.

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What is the cause of rhabdomyolysis

• Most common etiologic factors include alcohol or
  drug abuse, muscle compression and seizures.
• Complication of localized acidosis and sickling
  of RBCs in the muscle
• Other causes
• electrolyte disturbances, infections and
  inflammatory disorders

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What is the cause of rhabdomyolysis

• Subclinical enzyme defects
• inconsistent carbohydrate loading
• may add to the cause of dehydration
• High ambient temperatures
• high humidity
• lack of proper hydration.
• overzealous activity levels

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Who does it affect?

• Occurs in people who may have but not be limited
  to these people only.
• Sickle cell trait--the black population
• The Flu type A--the child
• Heat illnesses--the recreational athlete/athlete
• first seen in the military WWII

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Rhabdomyolysis

• The problem is with renal failure
• The release of cellular by- products makes this
  disorder deadly, but...
• with or without myoglobinuria, renal failure is
  thought to occur frequently in exertionl heat
  stroke, seldom in classic heat stroke.

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What the athlete will experience

• Symptoms
• tea, cola colored urinenot due to blood, but
  myoglobin released from damaged striated muscle.
• Muscle soreness and/or muscle spasms or pain.
• Eccentric workout.

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What happens to the athlete?

• After a unaccustomed strenuous workout severe
  case
• damaged muscle begins to release by-products into
  the extracellular tissue.
• Myoglobin--dark colored urnine
• 4 grams per kg of muscle--renal threshold of 300
  nanograms per ml of serum
• Creatine kinase
• Potassium

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• Myoglobin
• studies now show that this may not be the sole
  reason for renal shut down.
• Dehydration may be the culprit
• Most all cases look at involved some form of heat
  related illness.

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Heat related rhabdomyolysis

• Occurs in 25 of patients with exercised induces
  heat stroke
• involves the individuals ability to dissipate
  heat. High cardiac output.
• Classic heat stroke
• heat is transferred to the body from the
  enviroment
• Exertional heat stroke
• heat generated in the body due to extreme
  strenuous activities. ie firefighter, military

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What should we do for prevention

• Advise the coaches
• supply adequate fluids
• watch for heat related illness
• know your athletes

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Closing

• Every athlete has some form of mild
  rhabdomyolysis.---DOMS