Rhabdomyolysis in Belize

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vegan60

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i think this was an extremely rare occurance but if someone else can learn from my experience or help diagnose someone; hopefully this story will help. My husband and I dove Belize in May and did approx. 12 dives over 5 days. We dove 2-3 times every day and probably 3 of the dives (including Blue Hole) were over 100ft. On the 6th day there, I awoke with severe pain in my lower back on both sides- I assumed that I was severely dehydrated and drank a bunch of water. I was very tired and slept most of the day. That night, I awoke and started vomiting for 3 hours straight. My condition continued to deteriorate with muscle pains, confusion, inability to speak clearly, inability to urinate, bloating and finally severe leg tremors.

We were able to make it back to Atlanta and proceeded directly to the Emergency Room. I was diagnosed with Rhabdomyolysis which is deterioration of the muscles and acute renal failure. The Nephrologist assigned to my case said it was caused from over-exertion from the diving and dehydration. I was admitted to the hospital for 3 days where I received IV fluids and other medications to flush out the kidneys. Luckily, the kidney function returned to normal and there is no long-term damage.

So...my advice to any diver reading this story is ...hydrate, hydrate, hydrate and take your diving in moderation especially if you dive only 1-3 times/year. The Doctor says I can dive again, but believe me, I'll do it in moderation from now on.
 

rongoodman

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Interesting. I usually think of rhabdomyolysis in conjunction with crush injuries. 12 dives over 5 days seems like a light schedule(you might be doing twice that on a liveaboard trip). I'm glad you're doing better, but I wonder if something else wasn't going on.
 

MarineResearch

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Is there anything about your diet that may have been a contributing factor?
 
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Hank49

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Thanks for sharing that. That's pretty radical. I just came off a 9 day liveaboard with a bunch of friends. 110 miles out. Rhabdomyolysis could get serious really fast out there.
Glad you're ok. Did you only drink water?
 

Dive-aholic

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Interesting. I usually think of rhabdomyolysis in conjunction with crush injuries. 12 dives over 5 days seems like a light schedule(you might be doing twice that on a liveaboard trip). I'm glad you're doing better, but I wonder if something else wasn't going on.

Actually, dehydration is the number one cause of rhabdomyolysis. When I lived in Arizona I frequently took care of illegal aliens who were traveling through the desert for days with little to no water. Some of them were so dehydrated they ended up on dialysis. You may be thinking of compartment syndrome as far as the crush injuries go.
 

rongoodman

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No, I was thinking of rhabdomyolosis. I heard quite a bit about it when I was on the local USAR team. I did a little looking around after the original post went up and along with crush injuries, prolonged immobilization, and severe burns, found a number of references to extreme physical activity, such as running a marathon in hot weather or heavy workouts, but a couple of dives a day in tropical waters doesn't really seem to fit. That's why I was wondering if something else was going on.
 

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yodelhawk

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A good friend of mine went into rabdo after starting a cross fit workout. He was in very poor physical shape when he started and had 3 very mild work outs when it hit him. I think it does not take much if the conditions are right.
 

freewillie

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Here's a quick lesson in rhabdomyolysis.

By definition, rhabdo (for short) is defined as muscle injury where the levels of muscle enzyme creatanine kinase (ck) is 5 x's upper limit of normal. Another ezyme call myoglobin is also released into the blood along with CK and is measured in the urine as myoglobinuria. It is the myglobinuria that clogs up the kidneys and results in temporary (usually) renal failure.

The causes of rhabdomyolysis can be crush injuries, severe overuse of muscles (like running a marathon, not usual activity), associated dehydration with hyperthermia (but usually close to suffering heat stroke, not I feel a little hot today), drugs, viruses, and occasionally electrolyte disorders like low potassium.

Before any amateur doctors opinions come out, the above situations are almost always obvious, like getting hit by a car. Mild, and even moderate abnormalities, are generally not enough to produce rhabdo. In my experience the most common cause is either crush injury (and I do mean major crush inury) or pressure from an elderly person lying on a hard floor for hours (usually after fall and breaking a hip.) Even then the CK are mild to moderately elevated. The most severe case I've seen personally was a young kid on cocaine (one of the known drugs to cause rhabdo) who got hit by a car (crush injury) and then ran away (muscle use). The risk factors all played a role in what was a perfect storm and some eye popping levels of CK and urine myoglobin. Fortunately he was young and eventually made a full recovery. Usually I encounter elderly people who have been on the floor for a few hours.

I suspect that there were multiple factors leading the the OP's episode of rhabdo. While dehydration may have played a role I'm sure there are other factors that contributed. You didn't mention if there were any other drugs involved like a statin med for cholesterol. BTW the actual incidence of rhabo with a statin is about 0.5 %, not very frequent. About 11% patients will complain of the less severe form of myalgias where the muscles are sore but the CK is normal or only minimally elevated.

Another possible clinical scenario is the OP may have had AGE. I did note that the OP went to 100 ft three times during the trip. The symptoms of extreme fatigue and muscle soreness are also part of DCI/AGE syndromes. Theoretically if the diver suffers small gas emboli the affected muscles with suffer anoxic (not enough blood flow/oxygen) injury which leads to ischemic cell death. This would definitely lead to the elevated CK and possible rhabdo.

Glad to hear you made a full recovery.
 
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vegan60

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thanks to all for your input. A couple of additional things that may have contributed to my Rhabdo: I was on Benicar for high blood pressure which contains an diuretic and the day before the symptoms began I was sunbathing from 9am-5pm- so there may have been a bit of heatstroke involved. Regardless, the Nephrologist said it was the 'perfect storm' for Rhabdo without having a crush injury. He seemed to think that the deep dives had something to do with it. We went to 140 ft in the Blue Hole which is probably deeper than we should have gone. I'm better now!
 
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