Letter to the Editor
Rhabdomiolysis Secondary to Physical Activity and Simultaneous Electrostimulation. A Case Report
Rabdomiólisis secundaria a la realización de actividad física y electroestimulación simultánea: reporte de un caso
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A Case Report" "tieneTextoCompleto" => true "saludo" => "Mr. Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "262" "paginaFinal" => "263" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carlos Antonio Guillén Astete, Sixto Zegarra Mondragón, Carmen Medina Quiñones" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Carlos Antonio" "apellidos" => "Guillén Astete" "email" => array:1 [ 0 => "cguillen.hrc@salud.madrid.org" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Sixto" "apellidos" => "Zegarra Mondragón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Carmen" "apellidos" => "Medina Quiñones" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rabdomiólisis secundaria a la realización de actividad física y electroestimulación simultánea: reporte de un caso" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have recently assessed a 33-year-old female patient, an aerobic athlete who practises 180<span class="elsevierStyleHsp" style=""></span>min of swimming and 30<span class="elsevierStyleHsp" style=""></span>km (18.6<span class="elsevierStyleHsp" style=""></span>miles) of trotting per week, and who complained about proximal weakness and pain in lower limbs associated with noticeable volume increase in both thighs, of one day of evolution. Patient did not have any medical history of interest and was not taking any medication. The day before, she had used, for the first time, an electrostimulation device on the painful area while performing her regular exercises, which involved running on a treadmill for 30<span class="elsevierStyleHsp" style=""></span>min. The device consisted of short pants with electrodes for muscle stimulation of both glutei. The program used by the patient had a frequency of 50<span class="elsevierStyleHsp" style=""></span>Hz in accordance with the manufacturer's data sheet. The patient presented pain on palpation in quadriceps and lateral heads of triceps brachii and she showed proximal weakness that conditioned her pace. From the analytical point of view, she showed normal renal function, creatine phosphokinase (CPK) of 64,150<span class="elsevierStyleHsp" style=""></span>U/l, lactate dehydrogenase (LDH) 616<span class="elsevierStyleHsp" style=""></span>mg/dl, glutamate pyruvate transaminase (GPT) 640<span class="elsevierStyleHsp" style=""></span>UI/l, glutamate-oxalacetate transaminase (GOT) 1050<span class="elsevierStyleHsp" style=""></span>UI/l and myoglobinuria ++/+++. She was treated with overhydration and bed rest for 3 days, after which the pain ceased significantly; the thighs volume was reduced, the myoglobinuria disappeared and the CPK descended to 1222<span class="elsevierStyleHsp" style=""></span>U/l. Two months later, all analytes were normalised and the patient went back to her regular sport activity without presenting new symptoms until after 6 months from the episode. Approximately 3 months after the episode, she had an electromyography done which did not identify a pattern compatible with neuropathy or myopathy. A lactate test was performed with normal results.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Post-exercise rhabdomyolysis is a process that can present itself in healthy subjects or in patients with metabolic muscular diseases. It is characterised by a lysis of the musculoskeletal striated fibre after physical exertion that manifests itself clinically as the triad of myalgia, weakness and choluria.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1–3</span></a> Its management is mainly support-oriented, and it consists of athletic rest and overhydrating to prevent renal failure secondary to myoglobinemia.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4,5</span></a> In scientific literature, there is only one case of rhabdomyolysis associated with the use of an electrostimulation device in a young male patient who was exposed to such device for several weeks.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> Electrostimulation devices allow the performance of passive physical exercise through electrodes that generate isometric contractions in specific muscle areas.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> These devices are available for domestic use and at gymnasiums since their popularity lies on the promise of physical conditioning without the need of performing voluntary physical exertion. Our patient was exposed to electrostimulation once, which is a fact that stands out when comparing her case with the one described in 2004 by Guarascio et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> However, our patient performed her regular aerobic routine while carrying the electrostimulation device in both thighs. The complete analytical normalisation, the electromyographic study, the normality in the lactate test and the reincorporation to regular physical activity reasonably rule out that the patient suffers from any muscular metabolic disease. The main risk factors associated with the development of rhabdomyolysis are lack of physical conditioning and the performance of extreme muscular exertion.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> Our patient was a young woman who was used to physical activity. However, in our opinion, the use of a muscle electrostimulator while performing physical activity may generate tensile strengths capable of provoking the disruption of the muscle fibre's integrity with the well-known consequences. Due to lack of more cases, we cannot establish a universal recommendation advising against the use of electrostimulators. Nevertheless, common sense suggests that their use should not be made while performing active exercises.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Guillén Astete CA, Zegarra Mondragón S, Medina Quiñones C. Rabdomiólisis secundaria a la realización de actividad física y electroestimulación simultánea: reporte de un caso. Reumatol Clin. 2015;11:262–263.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosing exertional rhabdomyolysis: a brief review and report of two cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Walsworth" 1 => "T. 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| 2022 July | 50 | 40 | 90 |
| 2022 June | 25 | 34 | 59 |
| 2022 May | 37 | 40 | 77 |
| 2022 April | 38 | 49 | 87 |
| 2022 March | 41 | 48 | 89 |
| 2022 February | 42 | 32 | 74 |
| 2022 January | 61 | 49 | 110 |
| 2021 December | 29 | 41 | 70 |
| 2021 November | 39 | 44 | 83 |
| 2021 October | 47 | 52 | 99 |
| 2021 September | 37 | 41 | 78 |
| 2021 August | 30 | 55 | 85 |
| 2021 July | 64 | 39 | 103 |
| 2021 June | 27 | 39 | 66 |
| 2021 May | 42 | 29 | 71 |
| 2021 April | 84 | 90 | 174 |
| 2021 March | 52 | 35 | 87 |
| 2021 February | 43 | 24 | 67 |
| 2021 January | 34 | 18 | 52 |
| 2020 December | 35 | 25 | 60 |
| 2020 November | 27 | 26 | 53 |
| 2020 October | 20 | 15 | 35 |
| 2020 September | 37 | 19 | 56 |
| 2020 August | 29 | 25 | 54 |
| 2020 July | 16 | 36 | 52 |
| 2020 June | 38 | 28 | 66 |
| 2020 May | 37 | 15 | 52 |
| 2020 April | 23 | 18 | 41 |
| 2020 March | 21 | 17 | 38 |
| 2020 January | 1 | 0 | 1 |
| 2018 May | 5 | 1 | 6 |
| 2018 April | 41 | 10 | 51 |
| 2018 March | 44 | 11 | 55 |
| 2018 February | 42 | 2 | 44 |
| 2018 January | 18 | 6 | 24 |
| 2017 December | 43 | 5 | 48 |
| 2017 November | 25 | 4 | 29 |
| 2017 October | 18 | 6 | 24 |
| 2017 September | 16 | 9 | 25 |
| 2017 August | 16 | 6 | 22 |
| 2017 July | 25 | 8 | 33 |
| 2017 June | 39 | 11 | 50 |
| 2017 May | 46 | 9 | 55 |
| 2017 April | 28 | 4 | 32 |
| 2017 March | 27 | 14 | 41 |
| 2017 February | 17 | 9 | 26 |
| 2017 January | 36 | 5 | 41 |
| 2016 December | 56 | 14 | 70 |
| 2016 November | 43 | 5 | 48 |
| 2016 October | 57 | 13 | 70 |
| 2016 September | 48 | 8 | 56 |
| 2016 August | 45 | 3 | 48 |
| 2016 July | 34 | 7 | 41 |
| 2015 December | 3 | 0 | 3 |
| 2015 November | 1 | 16 | 17 |
| 2015 October | 3 | 22 | 25 |
| 2015 September | 2 | 0 | 2 |
| 2015 August | 5 | 41 | 46 |
| 2015 July | 24 | 30 | 54 |
Show all
