Exertional Rhabdomyolysis: A Retrospective Population-based Study

Abstract

Purpose This study aimed to evaluate the incidence and characteristics of exertional rhabdomyolysis (ER) in a population-based cohort. Methods A retrospective cohort study was performed in Olmsted County, Minnesota, from 2003 to 2015. Incident ER cases were ascertained through the Rochester Epidemiology Project medical record linkage system through electronic searches of the International Classification of Diseases, Ninth Revision, codes and clinical note text. Population incidence rate was calculated using the corresponding Rochester Epidemiology Project census populations specific to calendar year and sex. Descriptive statistics were used. Results Of the 430 patients, 431 cases met the inclusion criteria for rhabdomyolysis; 4.9% of cases (n = 20; males n = 18; Caucasian n = 17) were ER, with one recurrence. There were no deaths secondary to ER. The age- and sex-adjusted incidence rate of ER was 1.06 ± 0.24 (95% confidence interval = 0.59–1.52) per 100,000 person-years. Endurance activity (n = 7), manual labor (n = 5), and weight lifting (n = 4) were common causes. Complications included kidney injury (n = 5), mild electrolyte abnormalities (n = 10), elevated transaminases (n = 12), and minor electrocardiographic abnormalities (n = 4). A majority of patients were hospitalized (n = 16) for a median of 2 d, had mild abnormalities in renal and liver function and electrolytes, and were discharged without sequelae. Conclusion ER in the civilian population occurs at a much lower incidence than the military population. The most common causes were endurance exercise, manual labor, and weight lifting. The majority of cases were treated conservatively with intravenous fluid resuscitation during a brief hospital stay, and all were discharged without sequela. Only one case of recurrence occurred in this cohort, indicating the recurrence rate was low.

Exertional rhabdomyolysis: an analysis of 321 hospitalised US military service members and its relationship with heat illness

“…This study found significantly lower mean CK values in women and no differences based on military grade. In two similar studies, 80% (n=41)3 and 90% (n=20)8 of the exertional rhabdomyolysis cases were male. Men have higher muscle mass on average and therefore may present with higher CK levels when pushing through muscle fatigue.…”

“…The median LOS was 2 days. In another cohort study of 430 hospitalised rhabdomyolysis cases, only 21 were classified as exertional rhabdomyolysis with a median LOS of 2 days 8. The intense physical training and occupational demands of military service members place them at higher risk of exertional illness and injury.…”

Exertional Rhabdomyolysis in Athletes: Systematic Review and Current Perspectives

“…One combined the intravenous fluid with mannitol, baclofen, or ketorolac. 24 Other treatments included ice, massage, and heating pads, 27 or specific treatments like sickle cell treatment, respectively, alpha thalassemia trait. 26 The therapy, body height, weight, and BMI values are presented in Table 4.…”

“…These include the intake of supplements reported in 26 patients (25.0%, n 5 26/104). Other risk factors were medication such as NSAID in 7.7%,20 statin in 2.4%, 2 anabolic intake in 3.2%, 24 or other circumstances including ADHD, hypertension, infection, hypertension, hyperthermia, pulmonary/cardiac disease, and dyselectrolytemia. 2,21,25,26 All findings are illustrated in Table 3.…”

Exertional rhabdomyolysis in newly enrolled cadets of a military academy

“…1,4 Most studies have reported the possible associations between demographic characteristics and ER. However, few studies 7 have been conducted on training factors, health status, prevention measures, and other characteristics that may affect the occurrence of this condition. In particular, the key factors leading to the concentrated outbreak of a large number of cases are still to be explored.…”