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Case report
Rhabdomyolysis induced by long-term consumption of energy drinks associated with low intensity physical exercise: Case report
Rabdomiólisis inducida por consumo crónico de bebidas energizantes asociado a ejercicio físico de baja intensidad: reporte de caso
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Oscar Vicente Vergara Serpaa,
Corresponding author
osvergara@hotmail.com

Corresponding author.
, Carlos Andrés Reyes Jarabaa, Alonso Cortina Gutiérreza,b,c, Mario Enrique Montoya Jaramilloa,b, Oscar Darío Echenique Torresa
a Posgrado Medicina Interna, Facultad de Ciencias de la Salud, Universidad del Sinú, Seccional Cartagena, Cartagena, Colombia
b Servicio de Medicina Interna, Clínica Cartagena del Mar, Cartagena, Colombia
c Servicio de Reumatología, Clínica Cartagena del Mar, Cartagena, Colombia
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Received 20 August 2019. Accepted 31 March 2020
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Table 1. Paraclinical tests ordered during hospitalization.
Table 2. Paraclinical control tests after hospital discharge.
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Abstract
Introduction

The habit of consuming energy drinks is a life-threatening risk, because it can produce a syndrome characterised by a muscle necrosis. This promotes the release of enzymes and myoglobin from inside the myocyte into the circulation, creating lipid peroxidation and leading to acute kidney injury, and hyperkalaemia, together producing rhabdomyolysis. Rhabdomyolysis can be expected to be found within 24–48 h after strenuous activities, even more so with a modified BORG index greater than or equal to 5 points. However, energy drinks, due to their high content of caffeine and other components, can generate this little known adverse event.

Clinical case

A 37-year-old patient admitted to the emergency department due to clinical symptoms of myalgia, and dark urine that appeared 24 h after four days of low-intensity muscular exercises, and was associated with daily consumption of an energizing drink for 2 years. The diagnosis of rhabdomyolysis was confirmed by increased creatine kinase and transaminases. It was not possible to measure myoglobin levels. The patient was treated with aggressive fluid therapy. He never presented with any renal or electrolyte complications.

Conclusion

This case highlights the appearance of acute rhabdomyolysis in patients taking low intensity exercises, and not ruling out long-term consumption of energy drinks as the main cause. There are few cases currently reported in the literature. Owing to the timely treatment, progression to acute kidney injury was avoided.

Keywords:
Caffeine
Energy drink
Exercise
Hyperkalaemia
Myalgia
Rhabdomyolysis
Resumen
Introducción

un riesgo potencialmente mortal es el hábito de consumo de bebidas energizantes, porque puede producir un síndrome caracterizado por la necrosis muscular que promueve la liberación de enzimas y mioglobina proveniente del interior del miocito hacia la circulación, creando una peroxidación lipídica llegando a generar lesión renal aguda e hiperkalemia; conocido como rabdomiólisis. La rabdomiólisis la esperaríamos encontrar entre 24 a 48 horas después de actividades extenuantes, aún más con índice de BORG modificado mayor o igual a 5 puntos; sin embargo, las bebidas energizantes por su alto contenido de cafeína y otros componentes pueden generar este evento adverso poco conocido.

Caso clínico

paciente de 37 años, obeso, que ingresó al servicio de urgencias por cuadro clínico de mialgia y orina oscura que aparece 24 horas después de cuatro días de ejercicio muscular de baja intensidad, asociado a consumo diario de bebida energizante por 2 años. El diagnóstico de rabdomiólisis se confirma por hiperCKemia e hipertrasaminemia; no fue posible medir los niveles de mioglobina. El paciente fue tratado con fluidoterapia agresiva. Nunca presentó complicaciones renales ni hidroelectrolíticas.

Conclusión

nuestro caso destaca la aparición de rabdomiólisis aguda en pacientes sometidos a ejercicios de baja intensidad no descartando como causa principal el consumo crónico de bebidas energizantes. Son pocos casos actualmente reportados en la literatura. Gracias al tratamiento oportuno se evitó la progresión a lesión renal aguda.

Palabras clave:
Cafeína
Bebida energizante
Ejercicio
Hiperckemia
Mialgia
Rabdomiólisis

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