Abstract | November 9, 2021
Severe Rhabdomyolysis: In the setting of elderberry supplementation and a 30-minute moderate workout
Learning Objectives
- Recognize common causes and stressors that could induce rhabdomyolysis;
- Understand complications and lab abnormalities present in severe rhabdomyolysis;
- Differentiate severe rhabdomyolysis and the potential for other causes to increase the severity of presentation.
Introduction: Rhabdomyolysis is a condition involving skeletal muscle breakdown in the setting of a stressor leading to the release of creatine kinase (CK), lactate dehydrogenase, and myoglobin. Common causes include: crush injury, overexertion, alcohol abuse, and certain medications. Complications can involve hyperkalemia, acute renal injury, cardiac arrhythmias, and compartment syndrome, making early recognition, and treatment vital.
Case Presentation: We present a case of a 37-year-old male who presented to the ED for evaluation of myalgias and hematuria for two days after completing a 30-minute moderate intensity zoom workout. He noted that he had not exercised for two months prior, and on presentation, labs included an initial CK of 98,000, AST: 1276, ALT 290, creatinine 1.25, urinalysis with large blood, and no red blood cells. His only prescription medication was Fioricet as needed for migraines and he started taking elderberry supplements a week prior to presentation. He denied any weight loss, exercise supplements, illicit drug use, alcohol, or other herbal medications. He was started on aggressive IV fluid administration, and hospital course involved a peak CK level of 153,000 the following day. Aggressive hydration was continued with eventual decline in CK levels.
Through his hospital course, renal function continued to improve. Urine output was monitored and there were no concerns for compartment syndrome.
Conclusion: Given this patient’s rhabdomyolysis was nontraumatic, it is unlikely that this level of severe CK elevation was induced solely by exercise rather than a combination of other substances such as his new elderberry supplementation. His presentation was unique in the setting of significant CK levels despite only a moderate intensity 30-minute workout. Given the recent increased incidence in exertional rhabdomyolysis, cases like this serve as an example of the importance of early diagnosis and management for patients with similar presentations with other possible contributing risk factors.
