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Exercise rhabdomyolysis (breakdown of skeletal muscles) occurs more often in adults. It is characterized by muscle pain, muscle weakness, and darkened urine. A 17 year old boy was reported to have rhabdomyolysis after intensive physical training. He went first to his primary care physician because of muscle cramping. He got worse and he was brought to Saint Elsewhere Medical Center ER. His urine was dark and contained blood. A blood test called CPK (creatine phosphokinase, breakdown product of muscles) was 96,000 (a highly abnormal result). He had abnormal EKG showing peaked T waves consistent with high potassium in the blood (hyperkalemia). He was treated aggressive with medications and intravenous fluids. After two days of hospitalization he was better. He went home after 7 days of stay in the hospital. Reference: Pediatric Emergency Care, 13:382-385, 1997 [Comment: Although rhabdomyolysis is rare in children and teens, this condition should be always at the back of the mind of any primary care physicians in any teenager or child with severe muscle pain, muscle weakness, and dark urine. This condition is potentially dangerous because in severe cases, it could lead to kidney failure. High blood level of potassium can be dangerous too. The lesson here: any teenager who is playing intensively and gets muscle cramping should rest at once and not to continue the sports. If muscle pain persists, urine and blood tests should be done.] Leo Leonidas, MD, FAAP, Assistant Clinical Professor in Pediatrics, Tufts University School of Medicine, Boston; Attending Pediatrician, Eastern Maine Medical Center, Bangor, Maine.
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