Management of Rhabdomyolysis and Acute Renal Failure Following Strenuous Exercise in Young Adult: A Case Report

Introduction: Rhabdomyolysis is severe and life threating condition in which skeletal muscles are damaged by dissolution of striped muscles. Acute kidney injury (AKI) has been widely reported (13% - 50%) as a complication of Rhabdomyolysis in which the main pathophysiological mechanisms are intra-renal vasoconstriction, intraluminal cast formation (Tamm-Horsefall) and direct myoglobin toxicity. In this report we are going to describe the management of Acute Kidney Injury due to Rhabdomyolysis that is not responding to vigorous rehydration. Objective: Reporting about acute renal failure induced by Rhabdomyolysis due to Excessive Exercise and dehydration in young patient. Case Report: A 20 years male came to the outpatient clinic complaining of sever lower limb pain, back pain and vomiting. He was anuric and hypertensive (BP = 150/90 mmHg) with serum creatinine and urea levels of 15.72 mg/dl and 235 mg/dl, respectively. The diagnosis was based on the laboratory finding of creatine kinase = 3127 IU/l. The patient, then, has been referred to the emergency department. The Management plan was based on two arms: Emergency Management with Urgent Hemodialysis for AKI and high fluid replacement therapy. Patient started to recover after three hemodialysis sessions but the peak of recovery was noted after starting manual fluid replacement therapy with a target urine output of greater than 2 ml/kg, a urine pH of greater than 6. Manual fluid replacement therapy consisted of loop diuretics, intravenous fluids and intravenous sodium bicarbonate 1.26%. Full recovery was noted after one month of hospital admission with inpatient care and regular follow-up. A follow-up after one month has been set to assess the patient progression and monitor his kidney functions. Relevance and Impact: Home messages and lessons are;Firstly, young adults are vulnerable to Rhabdomyolysis, second, the diagnosis of Rhabdomyolysis can be made on the clinical bases but a confirmatory laboratory test of Creatine Kinase is mandatory, and lastly’ acute kidney injury needs to be treated urgently. Also, reducing the risk of infection is one of the management objectives to achieve recovery.

Comparison of the Levels of Five Heavy Metals in Human Urine and Sweat after Strenuous Exercise by ICP-MS

Inductively coupled plasma mass spectrometry (ICP-MS) was used to measure the levels of trace heavy metals in human urine and sweat, to compare the performance of ICP-MS using three sample processing methods, namely direct dilution, wet digestion, and microwave digestion. The results showed that the wet digestion ICP-MS method has the highest accuracy (relative standard deviation ≤10%) and is more useful for measuring the levels of trace heavy metals in urine and sweat. Hence, we used this method to compare the levels of the five trace heavy metals, namely chromium, copper, zinc, cadmium, and lead, in the urine and sweat of adults after strenuous exercise. The results showed that the levels of these five trace heavy metals in sweat were significantly higher than those in urine after strenuous exercise (The differences between the measurements in urine and those in sweat were significant P ≤ 0.01). The results suggested that exercise-induced sweating can effectively remove the harmful heavy metals from the human body.

Effect of Exhausting Exercise on Oxidative Stress in Health,Hemodialysis and Professional Sport

The aim of presented study is to compare parameters of oxidative stress in untrained volunteers, patients with chronic, non-motor related disease (dialysis patients) and professional athletes before and after exhaustive exercise. 40 subjects participated in the study: 14 healthy, untrained subjects, 12 hemodialysis patients and 14 professional rowers. Superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and non-transferrin bound iron (NTBI) were determined before and after exercise. Dialysis patients have increased oxidative stress at rest with highest NTBI, and show adaptation with increased values of GPx and decreased SOD. Professional athletes have low level of oxidative stress at basic circumstances with lowest NTBI, SOD, CAT and GPx as compared to untrained volunteers and dialysis patients. After strenuous exercise elevation of antioxidative enzymes is observed only in athletes, but not in untrained and dialysis patients. Due to limited antioxidative capacity, extreme physical effort is probably not recommended to dialysis patients and untrained people.

Intensity-specific considerations for exercise for patients with inflammatory bowel disease

The rising prevalence of inflammatory bowel disease(IBD)necessitates that patients be given increased access to costeffective interventions to manage the disease.Exercise is a non-pharmacologic intervention that advantageously affects clinical aspects of IBD,including disease activity,immune competency,inflammation,quality of life,fatigue,and psychological factors.It is well established that exercise performed at low-to-moderate intensity across different modalities manifests many of these diseased-related benefits while also ensuring patient safety.Much less is known about higher-intensity exercise.The aim of this review is to summarize findings on the relationship between strenuous exercise and IBD-related outcomes.In healthy adults,prolonged strenuous exercise may unfavorably alter a variety of gastrointestinal(GI)parameters including permeability,blood flow,motility,and neuro-endocrine changes.These intensity-and gut-specific changes are hypothesized to worsen IBD-related clinical presentations such as diarrhea,GI bleeding,and colonic inflammation.Despite this,there also exists the evidence that higher-intensity exercise may positively influence microbiome as well as alter the inflammatory and immunomodulatory changes seen with IBD.Our findings recognize that safety for IBD patients doing prolonged strenuous exercise is no more compromised than those doing lower-intensity work.Safety with prolonged,strenuous exercise may be achieved with adjustments including adequate hydration,nutrition,drug avoidance,and careful attention to patient history and symptomatology.Future work is needed to better understand this intensity-dependent relationship so that guidelines can be created for IBD patients wishing to participate in high-intensity exercise or sport.