Role of Creatine Phosphokinase in Predicting Acute Renal Failure in Hypocalcemic Exertional Heat Stroke

Abstract

Recruits frequently develop hypocalcemia in exertional heat stroke (ExHS) with rhabdomyolysis and acute renal failure (ARF) from intensive training. It usually indicated severe skeletal muscle damage. However, the relative risk of ARF in ExHS patients complicated with hypocalcemia was unknown. The present study was undertaken to evaluate the value of peak serum creatine phosphokinase (CPK) level in predicting ARF in ExHS patients with hypocalcemia. Sixty-eight army recruits with ExHS were hospitalized at the Tri-Service General Hospital, Taiwan: 17 with ARF and hypocalcemia (group A); 7 with ARF but without hypocalcemia (group B); 20 without ARF but with hypocalcemia (group C); and 24 without ARF or hypocalcemia (group D). In the 24 patients with ARF (groups A and B) the serum phosphate and peak CPK levels were significantly higher than in patients without ARF (groups C and D; p < 0.001), serum calcium levels were also significantly lower in the former (p < 0.001). In the 37 patients with hypocalcemia (groups A and C), the peak serum CPK levels were significantly higher than in those without hypocalcemia (groups B and D; p < 0.001). There was a higher proportion of hypocalcemic patients with peak serum CPK levels greater than 10,000 U/l among ARF compared with patients without ARF (χ² = 12.48, p < 0.001). In 24 patients with ARF, there was a negative correlation between serum Ca and peak CPK levels (t = 3.37, r = -0.58, p < 0.01). However, a positive correlation was found between serum creatinine and peak serum CPK levels in 37 patients with hypocalcemia (t = 2.47, r = 0.39, p < 0.02). In conclusion, hypocalcemia was found in 37/68 (54.4%) of ExHS patients. Peak serum CPK over 10,000 U/l increases the tendency of developing ARF; furthermore, it is unequivocally useful in predicting ARF in hypocalcemic ExHS patients.

Burnt Sugarcane Harvesting – Cardiovascular Effects on a Group of Healthy Workers, Brazil

“…Higher levels of CK and LDH are compatible with labor under conditions of physical overload and hydro-electrolyte imbalance, as evidenced in several studies [25], [26]. LDH and CK are biomarkers of muscular damage and may increase during situations of intense exercise, in which cell membranes become more permeable and enzymes are released into the interstitial matrix and reabsorbed via the lymphatic system to enter the bloodstream [26].The observation that CK remained high, even in blood samples measured 60 hours after exercise suggests a state of persistent hyperCKemia, much like that which occurs in athletes [26].…”

“…Although serum sodium is a less sensitive marker, the lower sodium and calcium levels observed during the harvest period can arise due to possible hydro-electrolyte disturbances associated with intense sweating and the intake of large quantities of water, which could explain the higher frequency of reported cramping in this period [25], [27]. Another study [28] reported the occurrence of hyponatremia among military personnel during intensive training, due to excessive water intake.…”

A Prospective Study of Calcium Metabolism in Exertional Heat Stroke with Rhabdomyolysis and Acute Renal Failure

“…ExHS in military recruits is not uncommon in Taiwan [9] despite several preventive measures being carried out. The present study evaluated patients with RBD early in the course of heat injury after exertion, as evidenced by the magnitude of the hyperphosphatemia and hypo calcemia, compared to the other reports [4,5], The re sults demonstrated hypocalcemia, decreased serum l,25(OH)2D levels and decreased ratio of l,25(OH)2D to 25(OH)D during the oliguric phase of ARF.…”

Heat illness in the U.S. mining industry

“…Disturbances of the central nervous system are common with confusion, ataxia, convulsions, or prolonged unconsciousness. Complications include hemorrhage, acute renal failure, rhabdomyolysis, liver failure, central nervous system damage, peripheral neuropathy, cardiac conduction abnormalities, a hypodynamic cardiac response, hypocalcaemia, and adult respiratory distress syndrome [Shibolet et al, 1967;Vertel and Knochel, 1967;Sohal et al, 1968;Kew et al, 1970Kew et al, , 1971O'Donnell and Clowes, 1972;Bouges et al, 1987;Shapiro and Seidman, 1990;Shieh et al, 1992]. None of these complications occur in heat exhaustion, which is caused primarily by dehydration [Donoghue et al, 2000;Donoghue, 2003].…”