Analysis of physiological markers and risk factors for the development of rhabdomyolysis in military personnel: a systematic review.

OBJECTIVES: To analyze case reports with individual patient data belonging to the Armed Forces submitted to specific physical or military combat training that was affected by rhabdomyolysis and identify factors that influenced the diagnosis and clinical evolution of the syndrome. CONTENT: We conducted a systematic review following the PRISMA guidelines and registered on PROSPERO (CRD42021242465). We searched MedLine (via PubMed), Scopus, Cochrane, Lilacs, SciELO, CINAHL, Web of Science, SPORTDiscus, ScienceDirect, and PEDro databases for studies that reported cases of military personnel affected by rhabdomyolysis. SUMMARY AND OUTLOOK: Thirteen studies met the inclusion criteria. Forty-nine individual cases of rhabdomyolysis were analyzed. From them, it was possible to identify several associated factors, which were responsible for developing rhabdomyolysis in military personnel. Thirty military personnel (60%) practiced physical training and 20 (40%) practiced specific military combat training. The creatine kinase (CK) peak ranged from 1,040 to 410,755 U/L, with an average of 44.991 U/L, and 14 (28%) of the cases reported alteration of renal function and four militaries (8%) evolved to death condition. Physical activities performed strenuously and without proper planning conditions such as room temperature, the period without adequate water intake, the amount of equipment used during the activity contributed to the development of rhabdomyolysis in the cases of military personnel analyzed in the present study. Therefore, it is recommended that future studies investigate the relationship between the prevalence of rhabdomyolysis cases and the severity of its consequence when associated with progressive methods of training, hydration control, acclimatization to austere environments, monitoring for the existence of hereditary diseases, and control of the use of supplementary nutritional substances.

Rhabdomyolysis Episode in an Individual with McArdle's Disease after Low Aerobic Exercise.

McArdle's disease, known as blockage of muscle glycogen metabolism, is characterized by glycogen accumulation of chains in skeletal striated muscles. One of the typical symptoms of the disease is the feeling of intolerance to exercise. Severe muscle cram and contracture, which often cause stiffness, occur due to a lack of muscle energy substrate during the exercise. These factors can lead to muscle damage, myoglobinuria, and, in severe cases, renal failure and rhabdomyolysis. Rhabdomyolysis is a syndrome that presents injury and necrosis of muscle cells leading to the release of intracellular material to the circulatory system. The present study aimed to report rhabdomyolysis in an individual with McArdle's disease after exercise of walking with low intensity. Patient, aged 33 years, was treated in the emergency room of a hospital located in the State of Rio de Janeiro, Brazil. After performing a full lap on the block of home (~500 m in ~4 min 37 s), walking at a moderate speed (~6.5 km/h), the individual felt sick and was rescued, later being hospitalized. The examinations collected presented hematocrit (HCT) compatible with chronic disease anemia and myoglobinuria. The patient was discharged from the intensive care center on the 3rd day, after a 45% drop in creatine kinase. The patient described in the present study achieved full recovery. Attention to symptoms, early diagnosis, and immediate treatment made it possible to interrupt the development of complications caused by rhabdomyolysis, not allowing progression to acute renal failure.