Rhabdo... increased incidence with ACEI's or bad genetics...?

[BravoKilo]

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Was hoping I could utilize the collective knowledge of everyone here to try and make some sense of a personal issue. Has anyone heard of an increased incidence of rhabdo while on ACE-I's? Not sure if the problem I have been having can be related to medication (10mg Quinapril QD) or ****ty genetics...

Basically, after novel exercises, or exercise after an extended period of time, I present with, in my unprofessional opinion, rhabdomyolysis -- extreme muscle soreness (and the inability to fully extend arms/legs/etc.) and dark urine despite increased fluid intake -- urine discoloration resolving within 1-2 days, and muscle soreness within 3-4. Strange thing is this only happens after long periods of inactivity... after the first 'incident' I will be fine in any successive workouts, even with increasing physical exertion. Not sure if it's related or not, but I also seem to have an increase in muscle cramping/soreness during these exercises. (Went rock climbing recently, and after 15-20 minutes I had claw-hands and my arms were useless).

I have come across a few sources online citing a possible increase risk of rhabdo with ACE-I's, but nothing too trustworthy.

What is the likelihood that this could be caused by my ACE-I (only medication I'm on) and not simply some unfortunate genetic predisposition? (23 years, active lifestyle, 'normal' BMI)

I've brought it up to a couple of my doctors in the past with rather inadequate results. Basically they dismiss it as simple muscle soreness after exercise. Have yet to bring a jar of coca-cola urine for further proof or testing...

And all that being said, I have an appointment scheduled in a few weeks for a physical and liver/kidney function, so no need to chide me for lack of medical attention (okay, maybe a bit).

Thanks for the help

 

[Priapism321]

Strange feeling this thread will be locked shortly.....extreme muscle soreness plus discolored urine = emergency room to me.

 

[BravoKilo]

Yeah, wasn't sure how this would go over... but for the record, these are incidents that have happened in the past, not something that I am currently experiencing. Was looking for possible explanations for the symptoms, not as a replacement to proper medical attention.

 

[Aznfarmerboi]

Was hoping I could utilize the collective knowledge of everyone here to try and make some sense of a personal issue. Has anyone heard of an increased incidence of rhabdo while on ACE-I's? Not sure if the problem I have been having can be related to medication (10mg Quinapril QD) or ****ty genetics...

Basically, after novel exercises, or exercise after an extended period of time, I present with, in my unprofessional opinion, rhabdomyolysis -- extreme muscle soreness (and the inability to fully extend arms/legs/etc.) and dark urine despite increased fluid intake -- urine discoloration resolving within 1-2 days, and muscle soreness within 3-4. Strange thing is this only happens after long periods of inactivity... after the first 'incident' I will be fine in any successive workouts, even with increasing physical exertion. Not sure if it's related or not, but I also seem to have an increase in muscle cramping/soreness during these exercises. (Went rock climbing recently, and after 15-20 minutes I had claw-hands and my arms were useless).

I have come across a few sources online citing a possible increase risk of rhabdo with ACE-I's, but nothing too trustworthy.

What is the likelihood that this could be caused by my ACE-I (only medication I'm on) and not simply some unfortunate genetic predisposition? (23 years, active lifestyle, 'normal' BMI)

I've brought it up to a couple of my doctors in the past with rather inadequate results. Basically they dismiss it as simple muscle soreness after exercise. Have yet to bring a jar of coca-cola urine for further proof or testing...

And all that being said, I have an appointment scheduled in a few weeks for a physical and liver/kidney function, so no need to chide me for lack of medical attention (okay, maybe a bit).

Thanks for the help

Regardless of ACEI, extreme exercising over prolong period of time is a common factor for rhabdo. In my opinion, it is not life threatening and DOES NOT warrant an ER visit as priapism suggested. Only rhabdo I would worried about is if it is an isolated compartment such as your arm getting crushed by a falling building or if this is a common occurance (risk of acute kidney damage).

In fact there are actually people who are extreme weight lifter. In their perverse mind, they would exercise extremely on purpose just to get rhabdo so they can join the "rhabdo" club.

Although I am not trainined in diagnosising, it is obvious what you had was rhabdo. Although I havent heard of ACEI causing rhabdo, I dont believe it is a major factor as it is not cytotoxic.

 

[Priapism321]

Regardless of ACEI, extreme exercising over prolong period of time is a common factor for rhabdo. In my opinion, it is not life threatening and DOES NOT warrant an ER visit as priapism suggested. Only rhabdo I would worried about is if it is an isolated compartment such as your arm getting crushed by a falling building or if this is a common occurance (risk of acute kidney damage).

In fact there are actually people who are extreme weight lifter. In their perverse mind, they would exercise extremely on purpose just to get rhabdo so they can join the "rhabdo" club.

Although I am not trainined in diagnosising, it is obvious what you had was rhabdo. Although I havent heard of ACEI causing rhabdo, I dont believe it is a major factor as it is not cytotoxic.

Thank goodness you are not "trainined" in "diagnosising." But then again, who is?

Those body builders you speak of sound smart.....

Complications include: acute renal failure, cardiac dysrhythmias, severe electrolyte abnormalities, respiratory failure, 8% MORTALITY RATE; yeah, sounds pretty self limiting to me (http://www.springerlink.com/content/913j25x53002165v/fulltext.pdf).

Can you give me some evidence that "rhabdomyolysis is no big deal" please? And, do not link some website where a bunch of roided out freaks talk about how sweet HGH is and how cool it is to "get rhabdo on the weekends."

 

[Aznfarmerboi]

Thank goodness you are not "trainined" in "diagnosising." But then again, who is?

Those body builders you speak of sound smart.....

Complications include: acute renal failure, cardiac dysrhythmias, severe electrolyte abnormalities, respiratory failure, 8% MORTALITY RATE; yeah, sounds pretty self limiting to me (http://www.springerlink.com/content/913j25x53002165v/fulltext.pdf).

Can you give me some evidence that "rhabdomyolysis is no big deal" please? And, do not link some website where a bunch of roided out freaks talk about how sweet HGH is and how cool it is to "get rhabdo on the weekends."

Refer to link below ---> Mortality quoted there is 5 percent and really dependent on patient (hydration, age, health, other offending agents such as diuretics, etc).

 

[Priapism321]

Most of the info that I am presenting are from my rotation (and really, famous doctors whose words are the authority in medicine) at one of the most prestigious ER in the US if not world.

Rhabdo from a heavy work out simply while putting you at minor risk isnt worth going to ER (up to your clinical opinion). The complications you speak of are more toward severe rhabdo (as in crashing buildings onto your chest). The acute renal failure and cardiac dysrhythmias are due to electrolyte abnormalities when you have A LOT of muscle cells dying leaking electrolytes into the body.

Unfortunely, I cannot link you to such a general subject. However if you read your article, you will see that basic treatment for rhabdo is IVF and correcting electrolytes ONLY in crash injuries. In the summary of the article, note the words "life threatening rhabdo". If he was to go to the ER, they probably wont admit him for a long period of time. When they do, they will just monitor him while getting his CK levels and a quick ecg. Not worth 1000 dollar ambulance ride in my clinical opinion.

8% mortality IRRESPECTIVE of cause is what I read.....the only point I may agree on is that there are cases of ASYMPTOMATIC rhabdomyolysis that may be relatively harmless. But, inability to fully extend one's extremities and discolored urine does not fit that clinical picture.

The article I cited came from ER clinicians at Columbia; certainly the "really famous doctors" you speak of have published something in the area to "establish their authority" no?

 

[twester]

Huh, thread's not locked.

Rhabdo is a big deal and needs to be treated in an ER with agressive fluid replacement. Myoglobin is nephrotoxic and repeated bouts of mild rhabdo (if there is such a thing) can damage the kidneys beyond repair.

ACE inhibitors do not cause rhabdo. So your Doc will want to ask you lots of questions about your lifestyle and activities.

 

[MountainPharmD]

Mods must be asleep.....

 

[Aznfarmerboi]

.

 

[BravoKilo]

Out of curiosity, my question is why the need to lock the thread? Like I said, I started this thread in search of a possible explanation to symptoms I have presented with in the past, not as an alternate to medical treatment for a current state. If I had been using it to seek a professional medical opinion, I could understand the need to lock, but can't quite see it when all I'm looking for is knowledge.

 

[PharmaSynergy]

...some unfortunate genetic predisposition?

Since you mentioned genetics, this sounds like an interesting topic for more research...

Carnitine Palmitoyltransferase II Deficiency (myopathic form)

Carnitine palmitoyltransferase II (CPT II) deficiency is a disorder of long-chain fatty-acid oxidation. The three clinical presentations are: lethal neonatal form, severe infantile hepatocardiomuscular form, and myopathic form that is usually mild and can manifest from infancy to adulthood. While the former two are severe multisystemic diseases characterized by liver failure with hypoketotic hypoglycemia, cardiomyopathy, seizures, and early death, the latter is characterized by exercise-induced muscle pain and weakness, sometimes associated with myoglobinuria. Males are more likely to be affected than females.

Source: http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=gene&part=cpt2

 

[Allure]

Out of curiosity, my question is why the need to lock the thread? Like I said, I started this thread in search of a possible explanation to symptoms I have presented with in the past, not as an alternate to medical treatment for a current state. If I had been using it to seek a professional medical opinion, I could understand the need to lock, but can't quite see it when all I'm looking for is knowledge.

Because we're not allowed to give advices to personal health-related questions and you stated that you're on an ACEi and will go see a doctor soon, so in a way, it is a current problem and not a past problem (if it matters). Now, if you stated the question differently like saying, "Patient X is having blah blah blah", then it's ok for us to discuss it.

 

[BravoKilo]

Very interesting read... thanks for the link 🙂

Reason I mentioned genetics in the first place is my mother and a few of her siblings have had somewhat related issues... mainly the proclivity to muscle cramping during novel exercise, and subsequent myalgia/myositis, though most accounts seemed to be less severe and I never heard anything about discolored urine -- then again, I can't quite see my aunts/uncles freely discussing the topic in the event they were pissing coca-cola. Should prove to be an interesting discussion at the next family get-together 🙂

 

[DOCTORSAIB]

Some of the physicians on here need to review their basic sciences again.

How come McArdle's Dz (a Glycogen Storage Dz where there is deficiency in skeletal muscle glycogen phosphorylase) was not mentioned?

Rare but possible. I saw a pt with McArdles in FP rotation in med school.

 

[BravoKilo]

Because we're not allowed to give advices to personal health-related questions and you stated that you're on an ACEi and will go see a doctor soon, so in a way, it is a current problem and not a past problem (if it matters). Now, if you stated the question differently like saying, "Patient X is having blah blah blah", then it's ok for us to discuss it.

If I were to edit the original post, would it make the topic more kosher? And the upcoming appt. is for blood work as part of standard protocol for being on an ACEi, not specifically related to any current medical problem I may or may not have. (And as a matter of fact, I worked out today without issue).

I might be missing the point (or just nitpicking), but I don't see how posting here (given only a username and no profile info) provides any less anonymity than referring to a 'Patient X', and why only the latter is 'OK'..? Where exactly is this line drawn that discussing health info on 'Patient X' is fine and dandy, but in regards to myself it is not? Where does it become "personal" if neither subjects have a clear identity? (And I truly am posing this question, not just trying to be a PITA)


Thanks again to those posting with info

 

[Aznfarmerboi]

You were right pripaism.

http://www.emedicine.com/emerg/topic508.htm

However this begs the question (for learning purposes) --> medically speaking, if some one presents to the ER with rhabdo, the ER should treat because 1. cover your ass 2. IVF is cheap and it will improve outcome.

What IF we dont treat 30 year old male that is well hydrated from 3-4 hour of non stop heavy workout presenting with rhabdo? If any physcians can answer this, it would be interesting. Statistically and clinically speaking, what does the physican think? What if the physican was poster? Would he bring himself into the ER or do something else?

I hope mods dont close this post as it has been hijacked. . . and this is more of a professional discussion now.

 

[Allure]

I might be missing the point (or just nitpicking), but I don't see how posting here (given only a username and no profile info) provides any less anonymity than referring to a 'Patient X', and why only the latter is 'OK'..? Where exactly is this line drawn that discussing health info on 'Patient X' is fine and dandy, but in regards to myself it is not? Where does it become "personal" if neither subjects have a clear identity? (And I truly am posing this question, not just trying to be a PITA)

Don't quote me on this, but I think mainly because we do not want to be held reliable just in case something happens. You can't come back and say, "well...I got my health advices from SDN and now I'm dying"..lol...or something along that line.