Severe Dehydration with Cramping Resulting in Exertional Rhabdomyolysis in a High School Quarterback

Objective: We present a case of a unique pathophysiological injury involving severe dehydration, muscle cramping, and resultant rhabdomyolysis in a high school football player. Background: A 16 y old male football player (body mass = 69.1 kg, height =175.3 cm) reported to the ATC after the morning session on the second day of two-adays complaining of severe muscle pain and cramping. Upon arrival to the emergency department, intravenous (IV) fluid was administered and blood analysis revealed creatine kinase (CK) that peaked at 3363 IU·L (normal range=26-174 IU·L). Following initial testing, the athlete was transported to a children’s hospital for differential diagnosis. Differential Diagnosis: The physician suggested severe dehydration, exertional rhabdomyolysis, or myositis. CK testing revealed elevated levels indicating mild rhabdomyolysis. Treatment: Eight liters of IV fluid was administered within the 48 hr hospitalization period. Early fluid replacement is the key to managing acute exertional rhabdomyolysis. Uniqueness: To our knowledge, no reports of exertional rhabdomyolysis in an adolescent athlete have ever been reported. In addition, increased CK levels have been reported in contact football during preseason practices but players were participating in contact drills. Our athlete developed rhabdomyolysis even after being well conditioned and acclimated for exercising in pre-season non-contact conditioning practice. Conclusions: The athlete was released from the children’s hospital in stable condition on Day 5 post-incident with a CK level of 1550 IU·L. The athlete was cleared and returned to practice on Day 7, participated in all activities and was monitored for any return of symptoms.