Rabdomiólise induzida por exercício e risco de hipertermia maligna: relato de caso

Ricardo Barreira Uchoa; Cláudia Regina Fernandes

doi:10.1590/S0034-70942003000100009

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Rabdomiólise induzida por exercício e risco de hipertermia maligna: relato de caso

Exercise-induced rhabdomyolysis and risk for malignant hyperthermia: case report

Ricardo Barreira Uchoa; Cláudia Regina Fernandes

http://dx.doi.org/10.1590/S0034-70942003000100009 Braz J Anesthesiol, vol.53, n1, p.63-68, 2003

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JUSTIFICATIVA E OBJETIVOS: Rabdomiólise é a lesão do músculo esquelético com liberação dos constituintes da célula para o plasma. Exercício exaustivo e extenuante, especialmente em homens não condicionados, pode resultar em morbidade maior com hiperpotassemia, acidose metabólica, coagulação intravascular disseminada, síndrome do desconforto respiratório agudo e rabdomiólise. Tem sido sugerido que hipertermia maligna, choque térmico e rabdomiólise induzida por exercício são síndromes fortemente relacionadas. O objetivo deste relato é descrever um caso de rabdomiólise fulminante após exercício físico e a correlação do quadro com hipertermia maligna. RELATO DO CASO: Homem de 32 anos apresentou mal estar seguido de síncope após correr 2.350 m em prova de aptidão física. Foi levado ao hospital, evoluiu com insuficiência respiratória, bradiarritmia, hipotensão arterial e parada cardiocirculatória. Foi reanimado, ficou comatoso, com importante rigidez muscular, choque persistente, distúrbio de coagulação, acidose metabólica, hiperpotassemia, evoluindo para óbito em menos de 24 horas. A autópsia revelou edema agudo de pulmão, coagulação intravascular disseminada e insuficiência renal aguda conseqüente a rabdomiólise. CONCLUSÕES: Tem sido sugerido que rabdomiólise induzida por exercício e hipertermia maligna são síndromes fortemente relacionadas. O paciente evoluiu para óbito antes de qualquer investigação específica para hipertermia maligna. No entanto, é importante pesquisar a susceptibilidade para esta síndrome em seus familiares a fim de evitar eventos anestésicos com potencial risco para a vida

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BACKGROUND AND OBJECTIVES: Rhabdomyolysis is a skeletal muscle injury with cell components' release to plasma. Exhaustive exercise, especially in non-conditioned individuals, may result in severe morbidity such as hyperkalemia, metabolic acidosis, disseminated intravascular coagulation, acute respiratory distress syndrome and rhabdomyolysis. It has been suggested that malignant hyperthermia, thermal shock and exercise-induced rhabdomyolysis are closely related syndromes. This report aimed at describing a case of fatal rhabdomyolysis after physical exercise and its correlation with malignant hyperthermia. CASE REPORT: Male patient, 32 year-old, presented with discomfort followed by syncope after running 2,350 m in a fitness race. Patient was taken to the hospital, evolved with respiratory failure, bradyarrhythmia, arterial hypotension and cardiac arrest, being resuscitated. Nevertheless, patient became comatose with severe muscle stiffness, persistent shock, coagulation problems, metabolic acidosis, hyperkalemia and died less than 24 hours later. Autopsy findings revealed rhabdomyolysis-induced acute pulmonary edema, disseminated intravascular coagulation and acute renal failure. CONCLUSIONS: It has been suggested that malignant hyperthermia and exercise-induced rhabdomyolysis are closely related syndromes. Patient died before any specific investigation of malignant hyperthermia, but it is important to look for susceptibility for this syndrome within the family to avoid potentially life-threatening anesthetic events.

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References

Lord GM, Scott J, Pusey CD. Diabetes and Rhabdomyolysis. Br Med J. 1993;307:1126-1128.

Don BR, Rodriguez RA, Humprey YS. Acute Renal Failure Associated with Pigmenturia or Crystal Deposits. Diseases of the Kidney. 1996:1273-1282.

Hackl W, Winkler M, Mauritz W. Muscle biopsy for diagnosis of malignant hyperthermia susceptibility in two patients with severe exercise-induced myolysis. Br J Anaesth. 1991;66:138-140.

Hopkins PM, Ellis FR, Halsall PJ. Evidence for related myopathies in exertional heart stroke and malignant hyperthermia. Lancet. 1991;338:1491-1492.

Ogletree JW, Antognini JF, Gronert GA. Postexercise muscle cramping associated with positive malignant hyperthermia contracture testing. Am J Sports Med. 1996;24:49-51.

Kojima Y, Oku S, Takahashi K. Susceptibility to malignant hyperthermia manifested as delayed return to increased creatinekinase activity and episodic rhabdomyolysis after exercise. Anesthesiology. 1997;87:1565-1567.

Köchling A, Wappler F, Winkler G. Rhabdomyolysis following severe physical exercise in a patient with predisposition to malignant hyperthermia. Anaesth Intensive Care. 1998;26:315-318.

Nielsen C, Mazzone P. Muscle pain after exercise. Lancet. 1999;353:1062.

Larach MG, Localio AR, Allen GC. A clinical grading scale to predict malignant hyperthermia susceptibility. Anesthesiology. 1994;80:771-779.

Wappler F, Fiege M, Steinfath M. Evidence for susceptibility to malignant hyperthermia in patients with exercise-induced rhabdomyolysis. Anesthesiology. 2001;94:95-100.

Jardon OM. Physiologic stress, heat stroke, malignant hyperthermia: a perspective. Military Med. 1982;147:8-14.

Gronert GA, Antognini JF, Pessah IN. Malignant Hyperthermia. Anesthesia. 2000:1033-1052.

Larach MG, Localio AR, Allen GC. A clinical grading scale to predict malignant hyperthermia susceptibility. Anesthesiology. 1994;80:771-779.

Simon HB. Current concepts: hyperthermia. N Engl J Med. 1993;329:483-487.

Wappler F, Fiege M, Antz M. Hemodynamic and metabolic alterations in response to graded exercise in a patient susceptible to malignant hyperthermia. Anesthesiology. 2000;92:268-272.

Gronert GA, Thompson RL, Onofrio BM. Human malignant hyperthermia: awake episodes and correction by dantrolene. Anesth Analg. 1980;59:377-378.

Wappler F. Malignant hyperthermia. Rev Eur J Anesthesiol. 2001;18:632-652.

Leitão FBP, Cançado TOB. Hipertermia maligna. Rev Bras Anestesiol. 1996;46:302-312.

Bendahan D, Kozak-Ribbens G, Confort-Gouny S. A noninvasive investigation of muscle energetics supports similarities between exertional heat stroke and malignant hyperthermia. Anesth Analg. 2001;93:683-689.

Bourdon L, Canini F. On the nature of the link between malignant hyperthermia and exertional heatstroke. Medical Hypotheses. 1995;45:268-270.

Hackl W, Winkler M, Mauritz W. Muscle biopsy for diagnosis of malignant hyperthermia susceptibility in two patients with severe exercise-induced myolysis. Br J Anaesth. 1991;66:138-140.

Rosemberg H, Antognini JF, Muldoon S. Testing for Malignant Hyperthermia: Clinical Concepts and Commentary. Anesthesiology. 2002;96:232-237.

Rabdomiólise induzida por exercício e risco de hipertermia maligna: relato de caso

Exercise-induced rhabdomyolysis and risk for malignant hyperthermia: case report

Ricardo Barreira Uchoa; Cláudia Regina Fernandes

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