{
  "abstract": "Objectives To describe the clinical course and complications of exertional rhabdomyolysis, compare inpatient and outpatient management, and evaluate admission markers of acute kidney injury (AKI).Methods Prospective, multicentre study with consecutive inclusion of patients with rhabdomyolysis (creatine kinase (CK) ≥5000 U/L and/or myoglobin ≥1000 ng/mL) with exercise as the precipitating factor, presenting to the emergency departments of four hospitals in Oslo and Akershus, Norway (2019–2022). Management followed usual care. Primary outcome was AKI, defined by Kidney Disease: Improving Global Outcomes criteria.Results We included 136 patients with exertional rhabdomyolysis (median age 28 years, 55% male), mainly after strength training (106, 78%); 62 (46%) were managed as inpatients and 74 (54%) as outpatients. Management was similar in both groups, consisting of fluids, serial blood tests, with a median follow-up of 3 days. Complications were rare and no outpatients required escalation to inpatient care. Five (4%) patients developed AKI (median peak creatinine 217 µmol/L, 132–410). Other major complications (severe electrolyte disturbances and compartment syndrome) occurred only in those with AKI.All patients who developed AKI had serum creatinine above the normal reference range at admission, though a few patients with elevated creatinine did not develop AKI (95% specificity). The myoglobin-to-CK ratio (≥0.48) performed best among muscle injury biomarkers and might serve as a supportive high-risk marker (99% specificity).Conclusion No patient with a normal admission creatinine developed AKI in this cohort, supporting outpatient management as a safe option for otherwise healthy individuals when admission creatinine is within the reference range, provided follow-up is ensured.Trial registration number NCT04118608.",
  "authors": [
    {
      "affiliations": [
        "Department of Acute Medicine, Oslo University Hospital, Oslo, Norway",
        "Institute of Clinical Medicine, University of Oslo, Oslo, Norway"
      ],
      "name": "Marie Vangstad"
    },
    {
      "affiliations": [
        "Department of Nephrology, Oslo University Hospital, Oslo, Norway"
      ],
      "name": "Jon Arne Kro Birkeland"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway"
      ],
      "name": "Anne Kristine Gulsvik"
    },
    {
      "affiliations": [
        "Department of Acute Medicine, Oslo University Hospital, Oslo, Norway",
        "Department of Internal Medicine, Oslo University Hospital, Oslo, Norway"
      ],
      "name": "Ragnhild Louise Ervik"
    },
    {
      "affiliations": [
        "Institute of Clinical Medicine, University of Oslo, Oslo, Norway",
        "Department of Orthopedic Emergency, Oslo University Hospital, Oslo, Norway"
      ],
      "name": "Ingrid Oftebro"
    },
    {
      "affiliations": [
        "Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway",
        "Department of Medicine, Telemark Hospital, Skien, Norway"
      ],
      "name": "Fredrik Barth Brekke"
    },
    {
      "affiliations": [
        "Medical Intermediate Care Unit, Akershus University Hospital, Lørenskog, Norway"
      ],
      "name": "Omar Ahmed Akkouh"
    },
    {
      "affiliations": [
        "Department of Acute Medicine, Oslo University Hospital, Oslo, Norway",
        "Institute of Clinical Medicine, University of Oslo, Oslo, Norway"
      ],
      "name": "Dag Jacobsen"
    },
    {
      "affiliations": [
        "Department of Acute Medicine, Oslo University Hospital, Oslo, Norway"
      ],
      "name": "Mari Asphjell Bjornaas"
    }
  ],
  "title": "Exertional rhabdomyolysis: clinical features, management, complications and prediction of acute kidney injury",
  "uid": "48f815d8-6f71-55bf-9ca5-d1fadc2c1985"
}