Subject that gradually has been taking force within training centers, Rhabdomyolysis has been gaining notoriety and becoming the target of concern to practitioners of strenuous exercise. The intention of this article is to highlight the concepts, causes and symptoms of this disease.
The term rhabdomyolysis originates from the rabdomio word, which means skeletal muscle, and lysis, meaning break. This syndrome is characterized primarily by damage to skeletal muscles resulting in leakage of cellular contents, such as myoglobin, potassium, phosphate, enzymes, among
others.Among their first symptoms may include muscle pain, muscle weakness and the darkening of the urine (CRIDDLE, 2003).
Since, according Brandao Neto and Pereira (2009), rhabdomyolysis The term refers to muscle damage occurring to release their cellular components in the movement, when such components are filtered in the glomerulus may lead to renal dysfunction. Food and Drug Administration (FDA) initially described rhabdomyolysis from CPK levels above 10,000 U / L; More recently, the definition has been modified to be considered only when secondary damage occurs in an organ (typically renal failure) happens associated with elevated muscle enzymes.
The clinical presentation of rhabdomyolysis is often subtle a high index of clinical suspicion is necessary.
Symptoms are described as myalgia and muscle signals, hypersensitivity, weakness, muscle stiffness and contractures in only 50% of cases (Gabow, 1982). The presence of constitutional symptoms such as feeling of general malaise, nausea, vomiting, fever and palpitations, decreased urine output and changes in urine color (darker, reddish-brown) are other findings from the clinical history to take into consideration.
Below is the story of two doctors on the subject:
“The characteristic of complaints triad rhabdomyolysis is muscle pain, weakness, and dark urine. However, more than half of patients can not report muscular symptoms. Muscle pain, when present, is typically more prominent in proximal muscle groups such as thighs and shoulders and back pain, “says also nephrologist and medical Emergency Unit of Dr. Einstein. Miguel Angelo Goes Junior.
Other symptoms are more common in patients with severe cases of the syndrome include malaise, fever, tachycardia, nausea, vomiting and abdominal pain. “Reduction of diuresis and altered mental status can occur when there is acute kidney injury associated,” says dr. Goes Junior. (Source: einstein.br)
The most frequent causes of rhabdomyolysis are alcohol consumption, heavy and excessive exercise, traumatic muscle compression and the use of some drugs and drugs. However, we must pay attention to the source of the problem which is usually multifactorial resulting in a common consequence: the death of skeletal muscle cells with the release of its constituents into the systemic circulation.
We can group the causes of rhabdomyolysis in 10 large groups (GUIMARAES ROSA et al., 2004):
2) related to excessive muscle activity;
3) changes in body temperature;
4) occlusion or hypoperfusion of the muscular vessel;
7) electrolyte and endocrine disorders;
9) inflammatory muscle disease
10) metabolic myopathies
We will mainstream the occurrence due to strenuous exercise.
Excessive exercise can cause muscle necrosis and rhabdomyolysis. The untrained; hipocaliémicos (potassium is vasodilator muscle microvasculature) (VISWERSWARAN and GUNTUPALI, 1999); dehydrated and practicing eccentric exercise (eg. down stairs) or under extreme heat and humidity are at increased risk for the disease (Knöchel, 1990).
Studies have found that practicing physical exercises using loads of 80% of 1RM or greater cause oxidative stress (Margonis et al., 2007), one of the risk factors for rhabdomyolysis. Another factor to consider is the concentration of CK (GOMEZ-Cabrera et al., 2006), also considered a risk factor.
Therefore, the adequacy of the training overload is key to nullify risk factors for rhabdomyolysis, knowing that it is almost impossible to prevent large overloads for high-performance athletes.