Benign Exertional Rhabdomyolysis - Causes, Symptoms, and Treatment

Introduction:

Benign exertional rhabdomyolysis is the muscle breakdown that occurs due to strenuous exercise and regular exercise in extreme circumstances. The benign exertional rhabdomyolysis features include muscle pain and elevation of serum creatine kinase level. Myoglobinuria (the presence of an abnormally high level of myoglobin in the urine) might be associated with elevated serum creatine levels. The benign exertional rhabdomyolysis is primarily observed in athletes, military personnel, and individuals doing unaccustomed exercise. The unaccustomed activities will increase the severity of benign exertional rhabdomyolysis. The benign exertional rhabdomyolysis is considered to be the first genetic muscle disease. The mutation in type 1 ryanodine receptor RYR1 is present in most people affected with benign exertional rhabdomyolysis.

What Is Benign Exertional Rhabdomyolysis?

Benign exertional rhabdomyolysis describes the muscle breakdown caused due to strenuous exercises and by exercising in extreme circumstances, thereby causing muscle pain. The mild exertional rhabdomyolysis severity will increase with an increase in strenuous activities. The clinical features of benign exertional rhabdomyolysis include muscular pain. It is also observed that benign exertional rhabdomyolysis is most commonly present in athletes and military personnel. The benign exertional rhabdomyolysis is the condition presented to a variety of general practitioners and physicians in an emergency, sports medicine, internal medicine, neurology, neuromuscular field, and in the military. Some external factors will provoke the benign exertional rhabdomyolysis and worsen the case. Hyperhydration is done to manage the clinically significant case of benign exertional rhabdomyolysis.

What Are the Causes of Benign Exertional Rhabdomyolysis?

Benign exertional rhabdomyolysis is a condition that occurs due to strenuous exercise. The benign exertional rhabdomyolysis is caused by high-volume and high-intensity exercises. The excitation-contraction coupling of the muscle tissue is slightly disturbed in benign exertional rhabdomyolysis. Some of the causes of benign exertional rhabdomyolysis are mentioned below.

• Strenuous exercises.

• Unaccustomed physical exercise.

• Too much faster physical activity.

• Too novel heavy physical exercises.

• Increased injury to the sarcoplasmic reticulum.

• Injury to the sarcolemma.

• Increased cellular permeability to sodium.

• Energy production failure.

• Impaired sodium-potassium ATPase and Ca2+ATPase.

• Muscle contraction.

• Destruction of myofibrillar, cytoskeletal, and proteins in the membrane.

• Leakage in circulation.

• Multi-joint exercises.

Who Is at Risk of Benign Exertional Rhabdomyolysis?

There are some people at risk of developing benign exertional rhabdomyolysis. For example, benign exertional rhabdomyolysis is highly observed in military personnel. Some other people at risk of benign exertional rhabdomyolysis are mentioned below.

• Football players.

• Athletes.

• Professional athletes.

• Recreational athletes.

• Prisoners and soldiers.

• Military personnel.

• People who work out at the gym.

• Swimmers and swim coach.

• Gym trainers.

• Female lacrosse players.

• Sailors.

• Fishermen.

• Young rowing drillers.

• Research volunteers.

• Laboratory models.

What Are the Symptoms of Benign Exertional Rhabdomyolysis?

Some external factors will trigger benign exertional rhabdomyolysis. The symptoms of benign exertional rhabdomyolysis are muscle pain and dehydration. Some signs of benign exertional rhabdomyolysis are given below.

• Dehydration.

• Muscle pain.

• Heat stress.

• Localized edema.

• Generalized weakness.

• Myoglobinuria.

• Fatigue.

• Vomiting.

• Fever.

• Delirium.

• Oliguria.

• Muscle weakness.

What Are the Risk Factors of Benign Exertional Rhabdomyolysis?

Besides heavy exercises, benign exertional rhabdomyolysis is also triggered by acquired and certain provoking factors. Some acquired and provoking factors for benign exertional rhabdomyolysis are given below.

• Inadequate hydration.

• High ambient temperatures.

• Herbal weight loss.

• Use of ephedra and creatinine.

• Specific medical intakes such as statins and selective serotonin reuptake inhibitors.

• Illicit drugs.

• Alcohol.

• Viral illness.

• Resistance training.

• Mental stress.

• Use of supplements.

• Latent myopathies.

• Bacterial and viral infections.

• Use of analgesics and non-steroidal anti-inflammatory drugs.

• Heat stress.

• Exercises in different environmental settings such as running and crawling in the mud.

• Dive in freezing water.

• Exposure to electrical discharges.

• Trauma.

• Genetic factors.

• Disorders of calcium homeostasis.

• Structural myopathies.

• The sickle cell trait.

• RYR1 mutations.

What Is the Diagnosis of Benign Exertional Rhabdomyolysis?

The diagnosis is based on the history of symptoms and laboratory tests. The key symptoms of benign exertional rhabdomyolysis include muscle pain, generalized weakness, and myoglobinuria. Urine analysis is done, and myoglobinuria is evaluated. The creatine kinase level is also raised. The various diagnostic tools for diagnosing benign exertional rhabdomyolysis are mentioned below.

• History of symptoms.

• Personal history.

• Occupational history.

• Visible myoglobinuria, tea, or cola-colored urine.

• Increased creatine kinase level.

• Serum myoglobin levels are elevated.

• Renal function tests.

• Renal blood flow.

• Glomerular filtration rate.

What Are the Complications of Benign Exertional Rhabdomyolysis?

Sometimes, benign exertional rhabdomyolysis may lead to some complications. The mortality rate is increased with some risks associated with benign exertional rhabdomyolysis. Some of the risk factors for complications are mentioned below.

• Age factor, more than 50 years.

• Female sex.

• Hypocalcemia (a condition that occurs when the calcium levels in the blood are too low).

• Hyperphosphatemia (an electrolyte imbalance characterized by an increased phosphate level in the blood).

• Decreased bicarbonate.

• Kidney failure.

• Severe hyperkalemia (a high potassium (K +) level in the blood).

• Disseminated intravascular coagulation.

What Is the Treatment for Benign Exertional Rhabdomyolysis?

The benign exertional rhabdomyolysis has several methods of clinical approaches. The primary step is determining whether the benign exertional rhabdomyolysis condition has clinical significance. The various modes of treatment for managing people with benign exertional rhabdomyolysis are mentioned below.

The management of the physiological form of benign exertional rhabdomyolysis is mentioned below.

• Adequate rest.

• Eight hours of sleep at night is a must.

• Resting in a thermally controlled environment.

• Regular follow-up.

• Relax time from sports.

• Drugs and toxins causing rhabdomyolysis should be eliminated.

The clinical management of benign exertional rhabdomyolysis is given below.

• Hyperhydration and intravenous fluids are administered.

• Hemodialysis or peritoneal dialysis.

• Administration of mannitol.

• Sodium bicarbonate to treat acidosis.

• Additional supportive measures include avoiding strenuous exercises, limiting training and other advice to prevent fasting, avoiding sugar intake, and caffeine supplements.

• Avoid consumption of alcohol.

• Drink plenty of water.

Conclusion

Benign exertional rhabdomyolysis is the muscle breakdown caused due to strenuous exercises and unaccustomed physical exercises. The mild form of benign exertional rhabdomyolysis is unnoticed, and the symptoms include muscle pain, myoglobinuria, and increased creatine kinase. The benign exertional rhabdomyolysis is caused by other acquiring and provoking factors such as genetics, alcohol, and other supplements. The benign exertional rhabdomyolysis is common in sports and military personnel. The risk and complications of benign exertional rhabdomyolysis are avoided by adequate rest and sleep. Avoiding alcohol, strenuous exercises, and provoking factors will prevent the risk of benign exertional rhabdomyolysis and improve the quality of life.