Myoglobinurea is characterized by the passing of dark, reddish or coffee coloured urine and have difficulty or pain during micturation. In some individuals symptoms may not be noted until after the exercise is complete while others exhibit symptoms that prevent the completion of physical activity.
Diagnosis of exertional rhabdomyolysis is made through clinical signs and symptoms as well as blood analysis for elevations in levels of:
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all of which are enzymes found only inside muscle cells. Typically, CK levels peak approximately six hours after an episode of exertional rhabdomyolysis and return to normal within forty-eight hours while AST levels rise more slowly and may remain elevated for more than fourteen days after the onset of symptoms. LDH can remain high for over 2 months post episode. Treatment of exertional rhabdomyolysis is varied and may be dependent on the severity and frequency of the symptoms. In all cases is beneficial to allow muscle tissues time to heal and to allow the kidneys to rid the tissues of muscle enzymes. Generally, three weeks is sufficient recovery for most individuals, however those experiencing renal damage may require longer periods. Electrolyte therapy and fluid therapy (lactated Ringers solution) are useful to flush the tissues of muscle enzymes and may be able to correct any underlying electrolyte imbalances. NSAID’s and muscle relaxants may be administered to relieve spasm and pain as long as there is no renal damage suspected. Dimethyl sulfoxide, may be administered intravenously to aid in the clearance of muscle enzymes from the tissues. Alternative therapies such as massage may be used to increase relaxation and prevent adhesion formation during the convalescence period and may speed up recovery and improve the prognosis for return to previous levels of activity. Caution must be used however as massage may trigger exertional rhabdomyolysis or may lead to renal toxicity and failure if it liberates large amounts of muscle enzymes from the tissues. Exertional rhabdomyolysis may be avoided by proper conditioning, sufficient hydration, supplementation of electrolytes, selenium and vitamin E, feeding low carbohydrate-low protein diets, allowing full recovery from systemic disease before intense exercise is undertaken, and by reducing the exposure to stressful environments. Breeding of individuals who experience episodes of exertional rhabdomyolysis regularly should be avoided as there is evidence of genetic predisposition.
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