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01 January 2008

Myoglobinuria caused by exertional rhabdomyolysis misdiagnosed as psychiatric illness

Miroslaw BanasikABCDEF, Jakub KuzniarABCDEF, Mariusz KusztalCD, Tomasz PorazkoBD, Waclaw WeydeAD, Marian KlingerAD

Med Sci Monit 2008; 14(1): CS1-4 :: ID: 666312

Abstract

Background
Rhabdomyolysis is severe and acute skeletal muscle damage resulting in sarcolemma disruption. During injury, intracellular muscle contents are released into the plasma. The consequences may cause hypovolemia, electrolyte abnormalities, compartment syndrome, or even acute renal failure and dialysis.
Material and Method
We present the history of a patient in whom exertional rhabdomyolysis was misdiagnosed. A 20-year-old male police recruit was admitted to a psychiatric hospital because of complaints about black urine and severe thigh pain. Serum creatinine kinase (CK) was significantly elevated at 87,335 U/l. Urinalysis showed brown color and cloudiness. Serum myoglobin was also significantly increased. Aspartate aminotransferase was elevated as was alanine aminotransferase. Immediate intravascular fluid hydration and hospital rest under renal, metabolic, and hematological monitoring was performed.
Results

Conclusions
Gymnastic teachers and people at environmental risk of rhabdomyolysis, such as members of the armed forces, police, and supervisors of physical laborers, need to remember the risks of intensive and repetitive exercise. Symptoms such as dark urine, myalgia, and muscle weakness should immediately arouse suspicion of rhabdomyolysis. Especially dark-colored urine should always be investigated for the occurrence of rhabdomyolysis.

Keywords: Physical Exertion - physiology, Myoglobinuria - psychology, Mental Disorders - diagnosis, Rhabdomyolysis - urine, Diagnostic Errors

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750