Difficult Heat Illness Problems; EAMC & Rhabdomyolysis

Transcription

1 This This This Forms of Hat Illnss Difficult Hat Illnss Problms; EAMC & Rhabdomyolysis Jorg E. Gómz, M.D. Associat Profssor Txas Childrn s Hospital, Baylor Collg of Mdicin - Houston Hat syncop Exrcis Associatd Muscl Cramps Hat xhaustion Hat Strok Rhabdomyolyis Pag 1 Monitoring Hydration in Athlts Bfor & Aftr wighins, kp chart 3% wt loss saf > 3% wt loss - dangr Rplac 16 oz of watr for vry lb lost Chck urin color bfor bd EAMC Tratmnt Passiv strtching Ic massag Littl vidnc that ingstion of lctrolyt solution or IV infusion significantly abats EAMC Pag 2 Pag 3

2 Rcurrnt onst muscl EAMC with havy xrtion Efforts to rhydrat on th fild fail Usually arly sason Th Crampr Physiology of EAMC Not compltly undrstood Inconclusiv laboratory vidnc of lctrolyt disturbancs causing incras muscl xcitation lading to ttany Othr factors may contribut to incrasd motor unit activity Pag 4 Pag 5 Salt & Watr Balanc Sodium Loss/Rplacmnt Eichnr, t al. OU football playrs Cramprs incrasd volum lost as swat, incrasd salt contnt Avrag Amrican sodium intak 3400mg/d! Rcommndd uppr limit is 1200mg/d Rplacmnt during nduranc vnts mg/hr Salt and th Athlt Pag 6 Pag 7

3 Muscl Fatigu Cntral Fatigu Fatigu (acidosis) rsults in Incrasd firing of xcitatory motor nurons Dcrasd firing of inhibitory nurons Dcras in nuron activation at th cortical lvl rsults in dcras in maximal voluntary contraction (MVC) This may in turn rsult in gratr ffort to achiv th sam amount of work, rsulting in gratr muscl fatigu Pag 8 Pag 9 Mdicins That May Caus Cramps Diurtics furosmid Blood prssur mdicins Calcium-channl blockrs (nifdipin) ACE-inhibitors (nlapril) Statins lovastatin Bta-agonists (asthma) albutrol Cratin EAMC Prvntion Incras fluid and sodium intak Minimiz pr-dhydration Eliminat caffinatd & sugary drinks Improv conditioning Emphasiz strtching Ensur adquat rst Rviw mdications, rcrational substancs Pag 10 Pag 11

4 Cratin Phosphokinas (CPK) Lvls Normal U/lit May b highr in African-Amricans (350) Modst lvations ( ) ar common aftr havy xrtion vn in athlts with minimal symptoms Muscl pain aftr intns activity May b widsprad or localizd to spcific muscl groups CPK < 20,000 Usually rsponds to rst, hydration Exrtional Myositis Pag 12 Pag 13 Rhabdomyolysis Injury whn xrcis intnsity/duration xcds working ability of muscls Hat, dhydration, acidosis, hypoxia acidosis lad to brakdown of skltal muscl, rsulting in laking of cllular products (myoglobin, protass, inflammatory mdiators) into th bloodstram Filtration of myoglobin causs rnal injury, protass damag lung Rhabdomyolysis - Diagnosis Intns muscl pain and waknss Lthargy, swlling, rspiratory distrss, tndr muscls CPK lvls > 20,000 Evidnc of rnal failur (BUN/Cr) Pag 14 Pag 15

5 Tratmnt of Rhabdomyolysis Hospitalization IV Fluids Analgsics Rturn to Play No symptoms CPK lvls normal No vidnc of kidny, livr, or lung failur Monitoring of organ function (CNS, livr, kidny) Pag 16 Pag 17 Hat Strss Tst Usd by som military forcs around th world Rquirs closly monitord xrcis in climat controlld (hot) nvironmnt Idal not practical Rhabdomyolysis - RTP Follow-up 1 wk aftr hospital discharg No symptoms, normal strngth Rpat rsting CPK lvls Exrcis challng (<70% MEHR, up to 20 min) Svr rhabdo (organ involvmnt) may bgin 2-4 wks aftr hospital discharg Lss svr (no or minimal organ involvmnt) may bgin 1 wk aftr discharg Post-xrcis CPK Gradual rturn to full activity ovr 2 wks Pag 18 Pag 19

6 This Highlights Factors that may contribut to EAMC prdhydration, inadquat watr & salt intak, lack of strtching, lack of rst Idal RTP valuation for xrtional rhabdomyolyisis not practical Gradual rturn to activity following priod an appropriat priod of rst, post-xrcis CPK lvls. Rfrncs Gomz JE. Environmntal Illnss. In, DL, Drz, Orthopdic, Principls & Practic, 4 th Ed Armstrong LE, t al. Exrtional hat illnss in training and comptition. Mdicin & Scinc in Sports & Exrcis 2007 Pag 20 Pag 21