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Exercise induced rhabdomyolysis  [PDF]
Ru?i? Maja,Fabri Milotka,Pobor Marta,Joveli? Aleksandra
Vojnosanitetski Pregled , 2009, DOI: 10.2298/vsp0909754r
Abstract: Introduction. Rhabdomyolysis is a potentially life threatening disease, characterized by the release of intracellular calcium from skeletal muscles and can result in acute renal failure. Case report. A nineteen year old boy was admitted to the Clinic for Infective Diseases of Clinical Center Novi Sad. The disease was developing gradually and the symptoms were dizziness, muscle pain and dark color of urine. Due to the pathological level of aminotransferase he was hospitalized on the fourth day of the disease beginning with a suspicious diagnosis of acute viral hepatitis. In the hospital course of the disease, a further elevation of serum aminotransferases, creatine kinase and lactate dehydrogenase were registered. Additional serological analyses were done to exclude other possible causes of acute liver lesion. In the neurological status prolonged decontraction of quadriceps muscle was detected and the electromyography was suspicious on neuromyositis. Conclusion. Excessive muscular activity with the strenuous exercise is the leading, but very frequently overlooked, cause of rhabdomyolysis in healthy people. Excessive physical exercise may lead to elevation of the serum activity of aminotransferases and to suspicion of hepatitis.
Spinning-induced rhabdomyolysis: importance of MRI for patient’s outcome. A case report  [cached]
R. Boni,P.G. Rabitti
Reumatismo , 2011, DOI: 10.4081/reumatismo.2011.44
Abstract: The first italian case of spinning-induced exertional rhabdomyolysis is presented here. The spinning is an expanding fitness activity which uses a stationary bike, that in some rare cases described in literature can induce rhabdomyolysis. In our patient, through magnetic resonance imaging, we detected a clear-cut temporal dissociation between clinical-biochemical healing and anatomical recovery. In fact we found that the improvement of magnetic resonance picture was much slower than the vanishing of myalgias and normalization of serum myoglobin and enzymes. This observation could be useful to understand the timing for exercise resumption without any risk for the patient.
Acute Renal Failure due to Rhabdomyolysis Caused by Hypokalemia  [cached]
Ghacha Reda,Sinha Ajit
Saudi Journal of Kidney Diseases and Transplantation , 2001,
Abstract: Rhabdomyolysis is not an uncommon cause of acute renal failure (ARF). It is usually caused by severe traumatic crush injury, severe exercise, septicemia, drug abuse, alcoholic intoxication, heat stroke and myopathy. In this case, we present a patient who developed rhabdomyolysis after severe hypokalemia (serum potassium 1.9mmol/L). This is an unusual cause of rhabdomyolysis even though hypokalemia is a common medical problem. This patient developed acute oliguric renal failure that required daily hemodialysis for 12 days, before start of recovery. This case demonstrates that hypokalemia is a preventable cause of rhabdomyolysis and ARF.
Hypothyroidism Induced Severe Rhabdomyolysis in a Hemodialysis Patient  [PDF]
Erhan Tatar,Tolgay Isikyakar,Kezban Pinar Yeniay,Hasan Huseyin Uzuner,Ebru Sevinc Ok
Case Reports in Medicine , 2014, DOI: 10.1155/2014/501890
Abstract: Hypothyroidism occurs relatively common and is a significant cause of morbidity and mortality during the course of chronic kidney disease. Rhabdomyolysis is a potentially life-threatening condition characterised by necrosis of muscular tissue and rarely associates with hypothyroidism. Here we describe a case of rhabdomyolysis due to severe hypothyroidism in a 56-year-old female hemodialysis patient. 1. Introduction Thyroid dysfunction is relatively common in patients with chronic kidney disease (CKD) when compared to general population [1, 2]. Both hormonal changes including alterations in TRH, TSH, and iodine clearance as well as presence of associating autoimmune disorders (type 1 diabetes mellitus or systemic lupus erythematosus) and comorbidities such as HCV infection or treatment with drugs having adverse thyroid effects (e.g., amiodarone) are thought to be responsible for thyroid dysfunction [2–4]. Thyroid dysfunction particularly hypothyroidism is a significant cause of cardiovascular mortality and morbidity in CKD patients [5–10]. In hemodialysis patients, however, the frequency of acute complications and neuromuscular effects of hypothyroidism are not known. Rhabdomyolysis is a rapid breakdown of skeletal muscle tissue leading to release of its contents into systemic circulation [11]. Rhabdomyolysis, a life-threatening condition, may occur due to physical factors including trauma, convulsions, or overexertion as well as to chemical and hormonal causes [11]. Hypothyroidism associated rhabdomyolysis is rare in nonuremic patients. Hypothyroidism induced rhabdomyolysis in dialysis patients has not been reported as far as we know. Here we present a case of rhabdomyolysis in a hemodialysis patient on amiodarone treatment receiving antithyroid therapy for subclinical hyperthyroidism. 2. Case Presentation A 56-year-old female with a past medical history of end stage diabetic nephropathy, interstitial pulmonary disease, congestive heart failure, and atrial fibrillation presented to nephrology outpatient clinics with complaints of nausea and fatigue. She was back on routine hemodialysis 4 times a week for 18 months (she underwent a renal transplantation 10 years ago). She provided a history of subclinical hyperthyroidism detected six months ago for which antithyroid treatment was started because of the diagnosis of a thyroid nodule. She stated that she missed her follow-up appointments. Her medications included warfarin 5?mg, diltiazem 30?mg, amiodarone 400?mg (started for atrial fibrillation with rapid ventricular response), propylthiouracil 300?mg,
Severe fenitrothion poisoning complicated by rhabdomyolysis in psychiatric patient.
Futagami K,Hirano N,Iimori E,Motomura K
Acta Medica Okayama , 2001,
Abstract: Non-traumatic rhabdomyolysis associated with organophosphate intoxication has not been generally reported. We report here in a severe case of fenitrothion poisoning complicated by rhabdomyolysis. A 43-year-old woman ingested approximately 100 ml of fenitrothion emulsion (50%) in an attempt to commit suicide. On day 3 after admission, her creatine phosphokinase (CPK) peaked at 47,762 IU/L. She received supportive treatment included sodium bicarbonate and fluid resuscitation. However, muscarinic symptoms including excessive miosis and salivation developed on day 5 when her CPK levels decreased. The delay in cholinergic symptoms might have been due to the trihexyphenidyl she took with the antipsychotic drugs. Fortunately, the present patient recovered from the acute cholinergic crisis, and acute renal failure was prevented by early diagnosis. This is a case of organophosphate poisoning complicated by rhabdomyolysis in a psychiatric patient. The masking of acute cholinergic symptoms should be taken into consideration in such patients.
Opium-Induced Rhabdomyolysis and Acute Renal Failure in a Patient Taking Opium Habitually: a Case Report  [cached]
Funda Sar?,Metin Sar?kaya,Ramazan ?etinkaya,Ay?e Jini Güne?
Erciyes Medical Journal , 2012,
Abstract: A 60-year-old male hypertensive and diabetic patient who took opium habitually for six months was sent to our hospital from a private hospital because of muscle weakness, rhabdomyolysis and acute renal failure. The laboratory tests revealed high serum creatine kinase, creatinine, myoglobin and lactate dehydrogenase. Intravenous hydration, bicarbonate and mannitol treatment were applied. During the follow-up period, the serum creatine kinase level and renal function tests gradually normalized. Although acute opiate drug intoxication can cause rhabdomyolysis, one of the causes of rhabdomyolysis is taking opium habitually. Here, we report a patient who presented with rhabdomyolysis and acute renal failure while using opium regularly. Physicians should keep in mind that habitual opium use can cause rhabdomyolysis and associated acute renal failure.
Rhabdomyolysis and acute renal failure after strenuous exercise and alcohol abuse: case report and literature review
Daher, Elizabeth De Francesco;Silva Júnior, Geraldo Bezerra da;Brunetta, Denise Menezes;Pontes, Lícia Borges;Bezerra, Glaydcianne Pinheiro;
Sao Paulo Medical Journal , 2005, DOI: 10.1590/S1516-31802005000100008
Abstract: context: rhabdomyolysis is a severe and life-threatening condition in which skeletal muscle is damaged. acute renal failure due to rhabdomyolysis has been widely described and its main pathophysiological mechanisms are renal vasoconstriction, intraluminal cast formation and direct myoglobin toxicity. objective: to report on a case of acute renal failure (arf) induced by rhabdomyolysis due to strenuous exercise and alcohol abuse and to describe the pathophysiology of this type of arf. case report: a 39-year-old man arrived at the hospital emergency service with swollen legs and lower extremity compartment syndrome. he was oliguric and had serum creatinine and urea levels of 8.1 mg/dl and 195 mg/dl, respectively. the diagnosis of rhabdomyolysis was made through clinical and laboratory findings (creatine kinase activity of 26320 iu/l). the initial treatment consisted of fluid replacement and forced diuresis. the specific treatment for compartment syndrome, such as fasciotomy, was avoided in order to prevent infection. partial recovery of renal function was recorded, after ten hemodialysis sessions. complete recovery was observed after two months of follow-up.
Fatal Acute Diclofenac-Induced Rhabdomyolysis in A Pediatric Patient  [cached]
Ahmet Güzel,Betül Orhaner Biner,Serap Karasaliho?lu,Hakan Aylan?
Balkan Medical Journal , 2011,
Abstract: Diclofenac, a widely used nonsteroidal anti-inflammatory drug, has been reported to cause fatal drug-induced rhabdomyolysis very rarely . We report a case of a 13-month-old girl who developed fatal rhabdomyolysis after administration of intramuscular diclofenac for relief of pain caused by a scalding burn injury. Rhabdomyolysis due to diclofenac has not been reported in children. Here, we present the first case report to demonstrate rhabdomylysis secondary to diclofenac administration.
Fenofibrate-induced rhabdomyolysis in a patient with chronic kidney disease: an unusual presenting feature of hypothyroidism
Sousa, Alessandra Alves de;Kronit, Hans Stauber;Neves, Francisco de Assis Rocha;Amato, Angélica Amorim;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2009, DOI: 10.1590/S0004-27302009000300015
Abstract: clinical and most often moderate skeletal muscle involvement is a frequent problem in adults with hypothyroidism, and includes a number of different manifestations. severe involvement with rhabdomyolysis, however, is very rare, and only a few cases have been reported to date, most of them with an additional factor of muscle injury. we described a patient with stage 3 chronic kidney disease who presented with rhabdomyolysis while taking fenofibrate, and was found to have hypothyroidism. we also highlighted the importance of excluding the diagnosis of thyroid dysfunction before treatment with lipid-lowering agents.
Sulfamethoxazole-Trimethoprim-Induced Rhabdomyolysis in an Immunocompetent Patient: A Case Report  [PDF]
Pamela M. Moye, Sara Manasen, Kristen O’Brien
Case Reports in Clinical Medicine (CRCM) , 2017, DOI: 10.4236/crcm.2017.612037
Abstract: Sulfamethoxazole-trimethoprim (TMP-SMX)-induced rhabdomyolysis is a rare complication of a commonly used antibiotic. This is a case report of a 43-year old immunocompetent African American woman with a history of depression and chronic alcohol consumption who presented to the emergency department (ED) with worsening bilateral leg pain. Before presentation, the patient was prescribed a twice daily dose of TMP-SMX for a urinary tract infection. The patient reported the development of intensifying leg pain after taking five doses of TMP-SMX. On presentation to the ED she was hemodynamically stable, afebrile, and leg pain intensity 10 out of 10. The patient admitted to daily alcohol consumption and taking vortioxetine 10 mg per day for treatment of depression. Initial labs drawn in the ED showed an elevated creatine kinase (CK) of 26,231 U/L and a normal serum creatinine (SCr) of 1 mg/dL. Through patient history and laboratory tests, common causes of rhabdomyolysis were ruled out. Treatment was initiated with IV fluids plus thiamine and folic acid supplementation, TMP-SMX was discontinued, and vortioxetine 10 mg per day was continued until hospital day five. The patient began to show improvement in lower extremity pain and tenderness and was discharged on hospital day eight with minimal residual leg pain and a CK of 2809 U/L. This case report presents only the third incidence of an immunocompetent patient developing TMP-SMX-induced rhabdomyolysis. This case highlights an opportunity for a pharmacist’s intervention and the need for future research to determine risk factors of TMP-SMX-induced rhabdomyolysis in immunocompetent patients.
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