1/30. "Abdominal crunch"-induced rhabdomyolysis presenting as right upper quadrant pain.A young, active duty sailor presented with right upper quadrant abdominal pain. history, physical, and laboratory findings initially suggested cholecystitis or related disease. Further evaluation found myoglobinuria and a recently increased exercise program, leading to the diagnosis of exercise-induced right upper abdominal wall rhabdomyolysis. Although not a common cause of abdominal pain, this diagnosis should be considered in the patient with abdominal pain and a recently increased exercise program, particularly exercises of the abdominal wall such as "abdominal crunches."- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/30. rhabdomyolysis associated with naltrexone.OBJECTIVE: To report a possible association between naltrexone therapy and the development of rhabdomyolysis in one patient. CASE SUMMARY: A 28-year-old white man in good physical health was started on naltrexone 50 mg/d for inpatient treatment of alcohol dependence and depression. A routine serum chemistry panel obtained on day 9 of naltrexone therapy showed marked new elevations in creatine kinase and aspartate aminotransferase. The patient remained asymptomatic and did not develop renal insufficiency. The serum enzyme concentrations returned to normal within eight days of naltrexone discontinuation. DISCUSSION: rhabdomyolysis has not been previously reported to occur in patients during treatment with naltrexone. alcoholism may result in a reversible acute muscle syndrome, but our patient did not fit the appropriate clinical profile for such a syndrome. Additionally, the other prescribed medications could not be implicated as possible causative agents. CONCLUSIONS: This case report illustrates a possible association between naltrexone therapy and rhabdomyolysis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/30. Diagnosing exertional rhabdomyolysis: a brief review and report of two cases.Exertional rhabdomyolysis is a potentially dangerous condition that involves release of intracellular contents from skeletal muscle in concentrations that may cause renal or other systemic complications. The purpose of the two case reports presented is to assist clinicians in recognizing this condition and in considering its predisposing factors. This paper describes two patients who, in the presence of several predisposing risk factors, developed exertional rhabdomyolysis. After diagnoses of rhabdomyolysis were reached, both patients were admitted to a local hospital for several days of monitoring and treatment. After 1 to 2 months of activity modification, both patients successfully resumed full physical activity and military duty.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/30. rhabdomyolysis triggered by an asthmatic attack in a patient with McArdle disease.We describe a patient with McArdle disease who developed rhabdomyolysis triggered by a bronchial asthmatic attack. A 64-year-old man had chronic pulmonary emphysema with asthma, and an asthmatic attack led to severe rhabdomyolysis that required continuous hemodiafiltration. After 2 years, a physical examination revealed atrophy of the extremities compared with previous examinations, especially of the intercostal muscles. During that time, he suffered two severe bronchial asthmatic attacks. His serum level of creatinine kinase remained between 4,000 and 7,000 IU/l when he did not suffer from asthmatic attacks and rhabdomyolysis had abated. Therefore, we suspected that his recent muscle atrophy was caused by asthmatic attacks, and discussed the possibility of his respiratory muscle weakness due to McArdle disease in relation to his severe bronchial asthmatic attacks as well as chronic obstructive pulmonary disease.- - - - - - - - - - ranking = 3.2943474223909keywords = physical examination, physical (Clic here for more details about this article) |
5/30. rhabdomyolysis associated with pneumococcal pneumonia: an early clinical indicator of increased morbidity?rhabdomyolysis most commonly results from crushing injuries, the toxic effects of drugs and alcohol, seizures, and strenuous physical activity. Though rhabdomyolysis has been rarely identified with bacterial pneumonia, it has recently been recognized that in the setting of legionella pneumophila pneumonia it has important prognostic implications. In the English literature, there are 12 well-documented cases of rhabdomyolysis associated with streptococcus pneumoniae pneumonia. Interestingly, in the majority of these patients, including ours, S. pneumoniae grew from their blood. bacteremia in patients with S. pneumonia doubles the death rate. Nine of the 12 patients, ours included, with S. pneumoniae pneumonia associated rhabdomyolysis developed renal dysfunction, as evidenced by an elevation in their blood urea nitrogen (BUN) and serum creatinine. uremia also indicates a poor prognosis in patients with pneumococcal pneumonia. serum creatinine phosphokinase (CPK) is a simple test that may allow early recognition of S. pneumoniae pneumonia in patients who are at an increased risk for a poor outcome, and permit timely therapeutic intervention.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/30. Successful conservative management of acute hepatic failure following exertional heatstroke.Acute hepatic failure is a rare complication of exertional heatstroke with poor prognosis. We herein report a 24-year-old man presenting with acute hepatic failure and rhabdomyolysis following exertional heatstroke during hard physical work on a construction site. Acute hepatic failure occurred after 2 days and led to massive impairment of coagulation parameters. On day 3 after heatstroke the patient fulfilled standard criteria for emergency liver transplantation (i.e. the 'london criteria' and the 'Clichy criteria') but was not transplanted. Nevertheless liver function improved spontaneously thereafter and the patient recovered completely within 12 days. In contrast, the outcome of emergency liver transplantation was dismal in three cases of exertional heatstroke in the literature. Thus conservative management appears to be justified in heatstroke-associated liver failure even in the presence of accepted criteria for emergency liver transplantation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/30. When pain is out of proportion.What happened to each of the patients? On re-examination, the first person was in tears and unable to lie still, even after 20 mg of i.v. morphine sulfate. Capillary refill was still intact, but he had lost sensation to the dorsum of the foot and was unable to dorsiflex his toes. He had a marked elevation of compartment pressure, and his creatinine phosphokinase (see below) was twice normal. In the OR, a fasciotomy was performed. Some muscle necrosis had occurred. In the second patient, fluids were infused rapidly on arrival at the ED via the i.v. route. He was given morphine sulfate for pain control while we awaited laboratory results. After about 45 minutes, he produced dark red urine. His creatinine phosphokinase (diagnostic muscle enzyme test) was 190,000--nearly 1,000 times above normal. He also had evidence of liver and kidney damage, but no electrolyte abnormalities. With aggressive treatment, including furosemide and sodium bicarbonate, his kidney and liver function returned to normal, he survived the ordeal and was discharged. The group leaders took the third patient to a local ED, where cellulitis was diagnosed and oral antibiotics were prescribed. The pain and fever increased, and significant discoloration began spreading up her hand over the next 24 hours. The second ED visit resulted in an admission. When the findings progressed despite i.v. antibiotics, surgical exploration was performed with drainage, debridement of devitalized tissue and a change in i.v. antibiotics. The common feature of all of these conditions is pain out of proportion to few, if any, findings on physical examination. Swelling that causes much of the damage in each condition is frequently not appreciated clinically until the condition is well advanced. Remember, what you see is not necessarily what you get.- - - - - - - - - - ranking = 3.2943474223909keywords = physical examination, physical (Clic here for more details about this article) |
8/30. Postoperative rhabdomyolysis with bariatric surgery.rhabdomyolysis has been reported in all postoperative patients including those in prone, supine, lithotomy and lateral decubitus positions. Only a few reports suggest that bariatric surgical patients are at risk for rhabdomyolysis. We describe a male (BMI 69 kg/m2) who underwent an uneventful open Roux-en-Y gastric bypass for weight reduction lasting 5 hours. Postoperatively the patient suffered oliguria. Evaluation included subjective pain in both hips, a normal temperature and physical examination, creatinine increase to 3.5 mg/dl, CPK levels as high as 41,000 IU/L, and urinalysis showing a large amount of occult blood with 5-7 RBCs/HPF. Intravenous hydration with 0.9% normal saline, bicarbonate, and mannitol demonstrated initial success, but the patient eventually developed renal failure, respiratory distress, and tachycardia leading to cardiac arrest. Prior to his death, intraoperative evaluation demonstrated intact anastomoses. Obese patients undergoing bariatric surgery should be considered at risk for rhabdomyolysis, especially in view of prolonged surgeries, difficult physical examination, low volume status, and larger or immobile patients.- - - - - - - - - - ranking = 6.5886948447817keywords = physical examination, physical (Clic here for more details about this article) |
9/30. Hyperosmolar non-ketotic diabetic syndrome associated with rhabdomyolysis and acute renal failure: a case report and review of literature.A 64-year-old man was admitted to our hospital because of general fatigue and drowsiness. On admission, a physical examination disclosed dehydration and a laboratory investigation revealed the following values: plasma glucose, 1309 mg/dl; serum sodium, 160 mmol/l; potassium, 3.0 mmol/l; urea nitrogen, 65 mg/dl; creatinine, 2.73 mg/dl; and plasma osmolarity, 403 mOsm/kg. urine ketone bodies were negative. A diagnosis of hyperosmolar non-ketotic diabetic syndrome was made, and hydration with an infusion of hypotonic saline (0.45%) and insulin therapy were immediately started. However, despite adequate rehydration and correction of blood glucose, his serum creatinine level increased to 3.1 mg/dl, while oliguria and myoglobinuria developed on the 4th hospital day, with serum creatine kinase increasing up to a maximum level of 16,749 IU/l, suggesting rhabdomyolysis. A final diagnosis of hyperosmolar non-ketotic diabetic syndrome associated with rhabdomyolysis and acute renal failure was made. His renal function gradually improved without hemodialysis, though acute renal failure due to rhabdomyolysis with hyperosmolar non-ketotic diabetic syndrome can sometimes be fatal. This rare case is presented along with a review of literature.- - - - - - - - - - ranking = 3.2943474223909keywords = physical examination, physical (Clic here for more details about this article) |
10/30. Strenuous exercise simulating hepatic injury during vaccine trials.Three healthy young men participating in phase 1 clinical vaccine trials had unexplained increases in their serum transaminase levels. Retrospective analysis indicated that these volunteers had participated in strenuous physical training 2-5 days prior to the noted elevations. The pattern of serum enzyme elevations, initially thought to be consistent with hepatic injury, were associated with parallel increases in creatine phosphokinase. One individual consented to repeat his exercise regimen. This was followed by a recurrence of the same pattern of increases in serum enzymes, including creatine phosphokinase. Thus, in trials where serum enzymes will be measured, it may be prudent to encourage subjects to refrain from increasing their activity above that which they normally perform.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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