[Health Lecture] Why was I admitted to the ICU after doing 200 squats?

Recently, a news report about a junior high school student in Hunan being admitted to the ICU due to suspected corporal punishment has attracted widespread attention. According to reports, the student was asked to do 200 squats by his head teacher because he was talking in class. He then developed a series of discomfort symptoms until he lost sensation in one of his legs and was admitted to the local People's Hospital. After a few days, he was sent to the intensive care unit of a higher-level hospital because his condition did not improve.

Why would doing 200 squats lead to such serious consequences? We have encountered similar cases in clinical practice before, which is clinically called "exercise-induced rhabdomyolysis."

1. Concept

Rhabdomyolysis refers to the change of stability and integrity of the sarcolemma due to trauma, ischemia, drugs, poisons, metabolic factors and infection, and the release of a large amount of muscle cell contents into the blood in a short period of time, causing tissue and organ damage. Exercise-induced rhabdomyolysis refers to the ischemia and hypoxia of skeletal muscle cells in the body caused by short-term, high-intensity and large-volume muscle exercise, and the destruction and disintegration of skeletal muscle cells, releasing their contents into the extracellular fluid and blood circulation. The large amount of myoglobin produced damages the glomeruli and renal tubules. In severe cases, acute renal failure and multiple organ dysfunction syndrome may occur.

reason

After exercise, we feel muscle soreness, which is a manifestation of lactic acid accumulation in skeletal muscle. When the amount of exercise is suddenly increased, the muscle fibers are overstretched violently, repeatedly, and for a long time at a high intensity. Under the stimulation of muscle strength threshold overload, the permeability of the muscle cell membrane changes, causing the muscle cells to be destroyed and disintegrated, and being "torn", releasing the contents (including creatine kinase, myoglobin, phosphate, potassium and uric acid, etc.) to the outside of the cell and into the blood circulation, thereby inducing rhabdomyolysis. The myoglobin produced is a large granular protein, which enters the kidneys with the blood and is decomposed in the kidneys and excreted from the body with urine. This process may damage the glomeruli and renal tubules, and in severe cases, it may even be complicated by acute renal failure and multiple organ dysfunction.

3. Clinical manifestations

The typical clinical manifestations of exercise-induced rhabdomyolysis are a triad: muscle pain, black urine (soy sauce-colored urine), and general weakness. However, more than 50% of patients do not present with typical symptoms. The actual clinical manifestations of exercise-induced rhabdomyolysis are diverse, mainly muscle swelling, pain, and changes in urine color (strong tea-like, red wine-like, or soy sauce-like). Other manifestations may include fever, general discomfort, tachycardia, nausea, vomiting, oliguria, and anuria. Severe cases may present with drowsiness and coma.

4. Complications

It has been reported that the incidence of exercise-induced rhabdomyolysis complicated by acute kidney injury is 51.0% and the mortality rate is 32.0%.

Liver damage.

Disseminated intravascular coagulation.

Compartment syndrome.

5. How to prevent it?

If you are a fitness enthusiast, exercise-induced rhabdomyolysis rarely occurs under normal circumstances. However, if you are a person who does not have the habit of exercising, you should start exercising gradually, with moderate-intensity aerobic exercise for more than 30 minutes 3-5 times a week. Occasionally exercising a lot at once will not only fail to have the effect of exercising the body, but may also easily lead to various sports injuries.

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About the Author:

Li Meng, Head Nurse

Head Nurse of the Infectious Diseases Department of Henan Hongli Hospital