Exertional Rhabdomyolysis After Crossfit Exercise Program

HISTORY: A 33-year-old previously healthy and physically fit law enforcement officer complained of fatigue, muscle soreness and swelling after a high intensity crossfit exercise workout. He reports having had 5 previous days of exercise but did not involve crossfit type training. After a prolonged and extreme crossfit exertional program, patient reported fatigue, shortness of breath, muscular weakness, and sleep disturbance, and went to the ED 3 days later. PHYSICAL EXAMINATION: Examination in the ED revealed upper extremity (arms and chest) muscle tenderness to light palpation, bicep/tricep compartment swelling and pectoralis major muscle swelling. Grip strength and DTR's in the triceps and biceps were normal. Patient had FROM in neck, shoulder, and wrist, but was difficult to perform full elbow flexion/extension limited by pain. DIFFERENTIAL DIAGNOSIS: Exertional Rhabdomyolysis Compartment Syndrome of upper extremity Muscle Diseases and Myopathy Acute Kidney Injury Metabolic disorders TEST AND RESULTS: Creatine Kinase: 26,000 IU/L UA: Positive blood with no RBC's Chem 7: Normal FINAL/WORKING DIAGNOSIS: Exertional Rhabdomyolysis TREATMENT AND OUTCOMES: Admitted to hospital for fluid IVF. Daily monitoring of CK, muscle soreness. After 6 days, patient was discharged from hospital with a CK of 995 IU/L. Returned to high intensity training after 4 months of mild to moderate aerobic training with appropriate instruction on high intensity workout recovery and hydration.