Exercise induced rhabdomyolysis. A case report

Background: Rhabdomyolysis is a clinical entity characterized by the release of intracellular elements after the destruction of skeletal muscle. The classic triad is characterized by the presence of muscle pain, weakness and dark urine, associated with elevated creatine kinase (CPK). The causes related to this syndrome are varied, with traumatic etiology, immobilization, sepsis, drug use, certain medications and alcohol consumption being the most common. CPK values are used for diagnosis and prognosis, with renal dysfunction being the most serious complication. Treatment is based on intensive and early fluid therapy to avoid kidney complications. All causes share a common pathogenesis, which can be explained by traumatic injury to the sarcolemma or by depletion of ATP (adenosine triphosphate) in the myocyte. The result of these alterations is the destruction of the muscle cell due to the increase in intracellular calcium and the subsequent persistent muscle contraction, mitochondrial dysfunction, the production of oxygen species and the activation of calcium-dependent proteases. Magnetic resonance imaging is the technique of choice to define the extent and distribution of muscle involvement. Its indication gains weight in those cases in which a fasciotomy is considered. Keywords: Rhabdomyolysis, CPK, ATP, renal replacement, urine.