Exertional Rhabdomyolysis: A Case of Markedly Elevated Creatine Kinase Without Acute Kidney Injury

Caffeine is a commonly used stimulant in our society. Prior case reports have described acute caffeine overdose resulting in rhabdomyolysis and acute kidney injury (AKI). We present the case of a 29-year-old man who presented to the emergency department after ingesting 20.1 g of caffeine in a suicide attempt and experienced AKI with only mildly elevated creatine kinase (CK). This case highlights the possibility that AKI can result from a caffeine overdose, even if the patient’s CK is only slightly elevated.

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How to do it: investigate exertional rhabdomyolysis (or not)

Practical Neurology ◽

10.1136/practneurol-2018-002008 ◽

2018 ◽

Vol 19 (1) ◽

pp. 43-48 ◽

Cited By ~ 7

Author(s):

Peter M Fernandes ◽

Richard J Davenport

Keyword(s):

Acute Kidney Injury ◽

Creatine Kinase ◽

Kidney Injury ◽

Underlying Disease ◽

Serum Creatine Kinase ◽

Muscle Disease ◽

Initial Presentation ◽

Organ Support ◽

Exertional Rhabdomyolysis ◽

Substantial Rise

Rhabdomyolysis is the combination of symptoms (myalgia, weakness and muscle swelling) and a substantial rise in serum creatine kinase (CK) >50 000 IU/L; there are many causes, but here we specifically address exertional rhabdomyolysis. The consequences of this condition can be severe, including acute kidney injury and requirement for higher level care with organ support. Most patients have ‘physiological’ exertional rhabdomyolysis with no underlying disease; they do not need investigation and should be advised to return to normal activities in a graded fashion. Rarely, exertional rhabdomyolysis may be the initial presentation of underlying muscle disease, and we review how to identify this much smaller group of patients, who do require investigation.

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Case Report: Exertional rhabdomyolysis in a spin class participant with sickle cell trait

F1000Research ◽

10.12688/f1000research.16326.2 ◽

2019 ◽

Vol 7 ◽

pp. 1742

Author(s):

Teresa Longo ◽

Matthew Shaines

Keyword(s):

Acute Kidney Injury ◽

Creatine Kinase ◽

Case Report ◽

Sickle Cell ◽

Renal Injury ◽

Sickle Cell Trait ◽

Kidney Injury ◽

Exertional Rhabdomyolysis ◽

At Risk Populations ◽

First Time

Exertional rhabdomyolysis is more common in sickle trait due to a predisposition to dehydration and inability to concentrate the urine. Spinning, an indoor cycling workout, has been associated with exertional rhabdomyolysis in recent reports. A consequence of rhabdomyolysis is acute kidney injury, which may be expected to be more common in patients with sickle trait. We report a case of spinning induced rhabdomyolysis in a woman with sickle trait that did not result in renal injury. “Spin rhabdo” is thought to be more severe than other causes of exertional rhabdomyolysis and is associated with higher creatine kinase levels than other causes of exertional rhabdomyolysis. Therefore, individuals with known sickle trait should consider visiting their physician prior to participation in spin classes for the first time. We might also consider voluntary screening for sickle trait in at risk populations prior to enrolling in spin classes given that many patients are unaware of their sickle trait status.

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Case Report: Exertional rhabdomyolysis in a spin class participant with sickle cell trait

F1000Research ◽

10.12688/f1000research.16326.1 ◽

2018 ◽

Vol 7 ◽

pp. 1742 ◽

Cited By ~ 2

Author(s):

Teresa Longo ◽

Matthew Shaines

Keyword(s):

Acute Kidney Injury ◽

Creatine Kinase ◽

Case Report ◽

Sickle Cell ◽

Renal Injury ◽

Sickle Cell Trait ◽

Kidney Injury ◽

Exertional Rhabdomyolysis ◽

At Risk Populations ◽

First Time

Exertional rhabdomyolysis is more common in sickle trait due to a predisposition to dehydration and inability to concentrate the urine. Spinning, an indoor cycling workout, has been associated with exertional rhabdomyolysis in recent reports. A consequence of rhabdomyolysis is acute kidney injury, which may be expected to be more common in patients with sickle trait. We report a case of spinning induced rhabdomyolysis in a woman with sickle trait that did not result in renal injury. “Spin rhabdo” is thought to be more severe than other causes of exertional rhabdomyolysis and is associated with higher creatine kinase levels than other causes of exertional rhabdomyolysis. Therefore, individuals with known sickle trait should visit their physician prior to participation in spin classes for the first time. We might also consider voluntary screening for sickle trait in at risk populations prior to enrolling in spin classes given that many patients are unaware of their sickle trait status.

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T1956 Incidence of Elevated Creatine Kinase and Acute Kidney Injury in Acute Liver Failure

Gastroenterology ◽

10.1016/s0016-5085(10)63852-8 ◽

2010 ◽

Vol 138 (5) ◽

pp. S-836

Author(s):

Shannan R. Tujios ◽

Linda S. Hynan ◽

Miguel A. Vazquez ◽

Corron M. Sanders ◽

William M. Lee

Keyword(s):

Acute Kidney Injury ◽

Creatine Kinase ◽

Liver Failure ◽

Acute Liver Failure ◽

Kidney Injury ◽

Elevated Creatine Kinase

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Visits of patients with exertional rhabdomyolysis to the Emergency Department at Landspítali, The National University of Iceland in the years 2008-2012

Læknablaðið ◽

10.17992/lbl.2016.03.71 ◽

2016 ◽

Vol 102 (03) ◽

pp. 131-135

Author(s):

Arnaldur Björn Halldórsson ◽

◽

Elísabet Benedikz ◽

Isleifur Ólafsson ◽

Brynjóldur Mogensen ◽

...

Keyword(s):

Acute Kidney Injury ◽

Creatine Kinase ◽

General Population ◽

Kidney Injury ◽

Fluid Replacement ◽

Capital Region ◽

Exertional Rhabdomyolysis ◽

Sport Practice ◽

National University ◽

Muscle Groups

Introduction: Overexertion and too much training are among the multiple etiologies of rhabdomyolysis. Creatine kinase (CK) and myoglobine, released from skeletal muscle cells, are useful for diagnosis and follow-up. Acute kidney injury is a serious complication of myoglobinemia. Literature on exertional rhabdomyolysis in the general population is scarce. The aim of this study was to investigate the epidemiology of exertional rhabdomyolysis among patients diagnosed at Landspítali The National University Hospital of Iceland in 2008-2012. Materials and methods: The study was retrospective and observational. All patients presenting with muscle pain after exertion and elevated creatine kinase >1000 IU/L, during the period from 1 January 2008 to 31 December 2012, were included. Patients with CK elevations secondary to causes other than exertion were excluded. Variables included: patient number and gender, CK-levels, date of hospital admission, cause of rhabdomyolysis, location of injured muscle groups, length of hospital stay, complications and means of fluid replacement. Population figures of the capital region were gathered from Statistics Iceland and information on sport practice in the capital region from The National Olympic and Sports Association of Iceland. Results: Exertional rhabdomyolysis was diagnosed in 54 patients, 18 females (33,3%) and 36 males (66,7%), or 8,3% of rhabdomyolysis cases from all causes in the study period (648 cases). Incidence in the capital region was 5,0/100.000 inhabitants per year in the study period. Median age was 28 years and median CK-level was 24.132 IU/L. CK-levels were higher among females but the difference between genders was not significant. Muscle groups of the upper and lower extremities were most frequently affected (89%). Thirty patients received intravenous fluids. They had significantly higher CK values than other patients. One patient developed acute kidney injury. Information on sport practice and physical training in the capital region was not available. Conclusion: Exertional rhabdomyolysis is uncommon but mostly affects younger people. Information on the practice of exertion among males and females is not available but CK-levels were not significantly different between genders, age groups or different muscle groups. CK-levels were high but complications uncommon. Studies of exertional rhabdomyolysis in the general population are lacking.

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Rhabdomyolysis and severe biphasic disturbance of calcium homeostasis secondary to COVID-19 infection

BMJ Case Reports ◽

10.1136/bcr-2020-239611 ◽

2021 ◽

Vol 14 (5) ◽

pp. e239611

Author(s):

Adrian Po Zhu Li ◽

Stephen Thomas ◽

Refik Gokmen ◽

Dulmini Kariyawasam

Keyword(s):

Acute Kidney Injury ◽

Creatine Kinase ◽

Calcium Homeostasis ◽

Kidney Injury ◽

Severe Hypercalcaemia ◽

Severe Hypocalcaemia

We report a case of severe hypercalcaemia secondary to rhabdomyolysis in a woman with COVID-19 (SARS CoV-2) infection. The patient presented with myalgia and anuria with an acute kidney injury requiring haemodialysis. Creatine kinase peaked at 760 000 IU/L. A biphasic calcaemic response was observed with initial severe hypocalcaemia followed by severe, symptomatic hypercalcaemia, persistent despite haemodialysis. Control of the calcium levels was achieved by continuous haemofiltration.

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Elevation of creatine kinase is associated with acute kidney injury in hospitalized patients infected with seasonal influenza virus

Clinical and Experimental Nephrology ◽

10.1007/s10157-020-02006-3 ◽

2021 ◽

Author(s):

Kento Ishibuchi ◽

Hirotaka Fukasawa ◽

Mai Kaneko ◽

Hideo Yasuda ◽

Ryuichi Furuya

Keyword(s):

Acute Kidney Injury ◽

Creatine Kinase ◽

Influenza Virus ◽

Seasonal Influenza ◽

Kidney Injury ◽

Hospitalized Patients

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Predictors of acute kidney injury in patients after extracorporeal cardiopulmonary resuscitation

Perfusion ◽

10.1177/02676591211049767 ◽

2021 ◽

pp. 026765912110497

Author(s):

Christopher Gaisendrees ◽

Borko Ivanov ◽

Stephen Gerfer ◽

Anton Sabashnikov ◽

Kaveh Eghbalzadeh ◽

...

Keyword(s):

Acute Kidney Injury ◽

Creatine Kinase ◽

High Risk ◽

Cardiopulmonary Resuscitation ◽

Hospital Mortality ◽

Hospital Stay ◽

Kidney Injury ◽

Dialysis Patients ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Outcome Parameters

Objectives: Extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly used due to its beneficial outcomes and results compared with conventional CPR. Data after eCPR for acute kidney injury (AKI) are lacking. We sought to investigate factors predicting AKI in patients who underwent eCPR. Methods: From January 2016 until December 2020, patients who underwent eCPR at our institution were retrospectively analyzed and divided into two groups: patients who developed AKI ( n = 60) and patients who did not develop AKI ( n = 35) and analyzed for outcome parameters. Results: Overall, 63% of patients suffered AKI after eCPR and 45% of patients who developed AKI needed subsequent dialysis. Patients who developed AKI showed higher values of creatinine (1.1 mg/dL vs 1.5 mg/dL, p ⩽ 0.01), urea (34 mg/dL vs 42 mg/dL, p = 0.04), CK (creatine kinase) (923 U/L vs 1707 U/L, p = 0.07) on admission, and CK after 24 hours of ECMO support (1705 U/L vs 4430 U/L, p = 0.01). ECMO explantation was significantly more often performed in patients who suffered AKI (24% vs 48%, p = 0.01). In-hospital mortality (86% vs 70%; p = 0.07) did not differ significantly. Conclusion: Patients after eCPR are at high risk for AKI, comparable to those after conventional CPR. Baseline urea levels predict the development of AKI during the hospital stay.

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Unusual Case of Localized Upper Limbs and Truncal Edema Associated with Fever, Anemia, and Acute Kidney Injury

Case Reports in Medicine ◽

10.1155/2019/6251426 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Mohammad Tinawi

Keyword(s):

Acute Kidney Injury ◽

Creatine Kinase ◽

Muscle Biopsy ◽

Unusual Case ◽

Kidney Injury ◽

The Other ◽

Upper Limbs ◽

Inflammatory Myositis ◽

Arm Pain ◽

Extensive Evaluation

The patient is a 75-year-old man who presented with right arm pain, edema, and erythema. The same manifestations appeared in the other arm 3 weeks later. He also developed fever, acute kidney injury, anemia, and truncal edema. Initial extensive evaluation was unrevealing. He was noted to have elevated creatine kinase, and a diagnostic muscle biopsy lead to diagnosis of inflammatory myositis. He improved with corticosteroids.

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