1999 Resident Poster Competition
Manisha S. Patwardhan M.D.
St. Luke's Medical Center
Exercise Induced Rhabdomyolysis (Mcardle's Disease) - A Case Report
McArdle's disease is a disorder of carbohydrate metabolism in which there is a deficiency of myophosphorylase enzyme. Clinical picture is characterized by exercise intolerance with muscle pain, stiffness and weakness during strenuous activity. Serum creatinine-phosphokinase at rest is variable increased and myoglobin may be found in urine. Diagnoses is confirmed by muscle biopsy with specific enzyme histochemistry showing absence of phosphorylase activity.
We present a 34 year old parole officer who presented to the E.R. with generalized myalgia and passing dark colored urine. Exam-non-focal. Lab data- BUN-119, creatinine-11.8, K-4.9, LDH-1473, total CK-21, 107. Urine analysis- Blood 3+, RBC-3-5. Renal ultrasound - bilaterally large kidneys with no focal mass lesion or hydronephrosis. Patient improved with vigorous I.V. hydration with his creatinine decreasing to 1.6, BUN - 27, LDH-301, total CK-2430 twelve days later. Patient had a muscle biopsy for repeated episodes of myalgia and myoglobinuria after vigorous activities which showed myophosphorylase deficiency consistent with the diagnosis of McArdle's disease.
This disease has an autosomal recessive pattern of inheritance. Avoiding vigorous activity needs to be emphasized to the patients to prevent muscle necrosis following prolonged, severe exercise. I.V. infusion of glucose, fructose, glucagon or sublingual isoproterenol have been suggested but none are of therapeutic value in the long term management.
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Alan D Forker, MD MACP
Missouri Chapter Governor
Patrick Mills
Missouri Chapter Executive Director
