Rhabdomyolysis – A Danger To Athletes!

 

Recently, I had a mother of a high school athlete document her (and her son’s) experience with a very serious bout of Rhabdomyolysis, which was totally unheard of at the time.  The fact that nobody talks about it or is aware of how to prevent or treat it is ridiculous!  With so many kids participating in sports and training harder than ever, I felt the need to make sure EVERYONE knows about it and can be prepared.  Rhabdomyolysis is the breakdown of muscle fibers that leads to the release of muscle fiber contents (myoglobin) into the bloodstream.   Myoglobin is harmful to the kidney and often causes kidney damage.

Right up front, the best way to prevent this condition is to drink plenty of fluids after strenuous exercise to dilute your urine and flush any myoglobin that is released from your muscles out of your kidneys.   Also drink a lot of fluids after any condition or event that may have damaged skeletal muscle.   Below is the account from the parent, Pam, that I mentioned earlier:

“Ok, I promise not to get on my soapbox.   But considering the week we just had, I honestly feel that it would be irresponsible for me not to post something.   Most of you know that Casey was hospitalized for 5 days with rhabdomyolysis.   This condition, in his case, was brought on by an intense work out.   His muscles broke down so severely that they released the protein myoglobin into his bloodstream.   A large amount of this protein causes kidney and liver failure.   If you google this condition, many articles will tell you that it is rare.   The reality is that it is becoming more common, especially in young athletes. There are even cases where several members of athletic teams are being hospitalized at the same time.   There was another child at CHOA when we were there in the ICU with kidney failure.   Casey was lucky and since I had heard of this before, we got to the hospital in time.   If your child complains of severe muscle soreness, please make sure their urine has not turned dark red or brown.   If it has, don’t wait.   And tell the ER what you suspect so they don’t waste time thinking it is a UTI or kidney stones.”

When muscle is damaged, a protein called myoglobin is released into the bloodstream.   It is then filtered out of the body by the kidneys.   Myoglobin breaks down into substances that can damage kidney cells.  Rhabdomyolysis may be caused by any condition that damages skeletal muscle, especially injury.

Symptoms are:

  • – Abnormal urine color (dark, red, or cola colored)
  • – Decreased urine production
  • – General weakness
  • – Muscle stiffness or aching (myalgia)
  • – Muscle tenderness
  • – Weakness of the affected muscles

 

Other symptoms that may occur with this disease:

  • – Fatigue
  • – Joint pain
  • – Seizures
  • – Weight gain (unintentional)

 

Typical treatment is as follows:

Getting fluids that contain bicarbonate may prevent kidney damage by quickly flushing myoglobin out of the kidneys.   Fluids may need to be given through a vein (by IV).   Some patients may need kidney dialysis.

Medicines that may be prescribed include diuretics and bicarbonate (if there is enough urine output).

Hyperkalemia and low blood calcium levels (hypocalcemia) should be treated right away, if present.  Kidney failure should also be treated.

 

Prognosis is:

The outcome depends on the amount of kidney damage.   Acute kidney failure occurs in many patients.   Getting treated soon after rhabdomyolysis begins will reduce the risk of permanent kidney damage.

People with milder cases may return to their normal activities within a few weeks to a month.   However, some people continue to have problems with fatigue and muscle pain.

We hope that this posting will help educate the parents and athletes out there, but should you need more answers or in depth details, please contact your family doctor to see what more you can do to prevent going thru what Pam and her son had to!  Remember, knowledge is powerful and the more you can do to be prepared and take the right steps of being healthy during your sports experience, the better!

 

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