Transient Exercise-Induced Water Intoxication and Rhabdomyolysis

Putterman, Chaim; Levy, Lídia; Rubinger, Dvora

doi:10.1016/s0272-6386(12)81095-x

Cited by 44 publications

(27 citation statements)

References 16 publications

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“…8 Although hyponatremiaassociated hyper-CKemia with water intoxication has been reported in several case reports, some of these presentations are confounded by the presence of coexisting causes of muscular injury such as seizures, intensive exercise and illicit drug use. 19,20 In comparison to others, the present study found a larger number of patients who had hyper-CKemia in the setting of diuretic-related hyponatremia. The temporal observations would suggest that the hyper-CKemia was more likely related to hyponatremia or hypo-osmolality as opposed to the diuretic agents.…”

Section: Discussioncontrasting

confidence: 62%

Asymptomatic elevation of creatine kinase in patients with hyponatremia

Khow

Lau

et al. 2014

Renal Failure

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Thirty-two patients with hyponatremia and hyper-CKemia were identified. All patients had no muscular symptoms or weakness. The commonest cause of hyponatremia in this cohort was related to diuretics (50%). The mean sodium level on presentation was 116.0 ± 6.9 mmol/L and the median peak CK was 895.5 (interquartile range: 610.8-1691.8) IU/L. Six (18%) patients developed acute kidney injury (AKI). The length of hospital admission of the entire cohort was 8.0 ± 5.8 days. Patients with hyper-CKemia in the setting of diuretic-associated hyponatremia were older and had longer hospital length of stay compared with primarypolydipsia-associated. Asymptomatic hyper-CKemia is an uncommon association with hyponatremia of various etiologies. Hyponatremia-associated hyper-CKemia can be complicated by AKI.

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Section: Discussioncontrasting

confidence: 62%

Asymptomatic elevation of creatine kinase in patients with hyponatremia

Khow

Lau

et al. 2014

Renal Failure

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“…Hyponatremia has been reported as a cause of rhabdomyolysis, presumably because of the hypo-osmolality of the extracellular fluid, leading to cell swelling [3, 28]. After several hours, cellular swelling is reduced, and the volume normalizes, as a result of extrusion of intracellular potassium causing increased blood flow to the area [29, 30].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in potassium-deficient cells, the cellular transmembrane potential is decreased, leading to rhabdomyolysis and release of creatine phosphokinase and myoglobin and subsequent myoglobinuria [30]. Noteworthy, of the 24 reported cases of hyponatremia-induced rhabdomyolysis, 12 had coexisting hypokalemia [3, 6, 9, 13, 15](table 2), and, as in our case and these previously reported ones, potassium depletion could have certainly played an additional role in the development of rhabdomyolysis. In our patient, creatine phosphokinase blood levels were measured 4 days after presentation, when important myalgias developed, and we regrettably lack previous levels.…”

Section: Discussionmentioning

confidence: 99%

“…Thiazides should be avoided in elderly individuals, but, if indicated, patients should be instructed to limit their fluid intake. Finally, we emphasize the need to monitor muscle enzymes in hyponatremic patients if muscle weakness or pain develop [3]. …”

Section: Discussionmentioning

confidence: 99%

“…However, hyponatremia is a rare cause of rhabdomyolysis, and, to our knowledge, only 24 cases have been reported [3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. …”

Section: Introductionmentioning

confidence: 99%

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Hyponatremia-Associated Rhabdomyolysis

Trimarchi

González

Olivero

1999

Nephron

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Background: Hyponatremia is the most frequent electrolyte disorder. However, hyponatremia rarely results from excessive water intake, unless the kidney is unable to excrete free water, such as in patients on thiazide diuretics; in addition, hyponatremia is an uncommon cause of rhabdomyolysis. Methods: We present a 51-year-old hypertensive woman on chronic hydrochlorothiazide therapy who developed acute water intoxication and severe myalgias. Results: The patient developed acute hypotonic hyponatremia and subsequent rhabdomyolysis. We discuss the mechanisms responsible for the development of hyponatremia and its association with rhabdomyolysis. Conclusion: Muscle enzymes should be monitored in patients with acute hyponatremia who develop muscle pain, and hyponatremia-induced rhabdomyolysis must be considered in patients with myalgias receiving thiazide diuretics.

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Renal handling of salt and water in humans during exercise with or without hydration

et al. 2001

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Plasma sodium (Na+) concentration, i.e. natraemia, results from body tonicity equilibrium. During exercise, a change in body tonicity can result from an imbalance between intake and loss of Na+, potassium (K+) and water (H2O) due to renal and/or extra-renal mechanisms. Whether exercise-induced changes in kidney function could be responsible for such an imbalance was studied by measuring glomerular filtration rate (creatinine clearance), proximal tubule activity (lithium clearance) and renal handling of Na+ and K+ at rest and during exercise. Since hyponatraemia during or after exercise has been reported, we also investigated whether a water load could be appropriately excreted during exercise. Ten young men pedalled on a cycle ergometer at 60% of maximal oxygen uptake for 45 min with (HE, hydrated exercise) or without (DHE, dehydrated exercise) a supply of water. In both conditions, creatinine, lithium, and electrolyte (Na+ + K+) clearances decreased and natraemia did not change. The DHE induced a loss of body mass (-1.29%), decreased diuresis and large extra-renal water loss [mean (SEM)] [880 (73) ml]. The HE led to no loss in body mass, increased diuresis and lower extrarenal water loss [680 (48) ml]. Electrolyte-free water excretion, negative for DHE, represented 60% of diuresis during HE. Thus the kidney, by increasing electrolyte reabsorption mainly in the proximal tubule, and appropriately excreting a water load, seems efficacious in regulating extracellular fluid volume and body tonicity and so not responsible for the imbalance between (Na+ + K+)/H2O intake and loss. Therefore, extra-renal changes could be the main causes of exercise-induced tonicity imbalances which could ultimately lead to dysnatraemia.

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Transient Exercise-Induced Water Intoxication and Rhabdomyolysis

Cited by 44 publications

References 16 publications

Asymptomatic elevation of creatine kinase in patients with hyponatremia

Asymptomatic elevation of creatine kinase in patients with hyponatremia

Hyponatremia-Associated Rhabdomyolysis

Renal handling of salt and water in humans during exercise with or without hydration

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