Severe Rhabdomyolysis Without Electrolyte Abnormalities or Renal Failure and With Disproportionately Low AST

Area of Science:

• Sports Medicine
• Clinical Pathology
• Nephrology

Background:

• Rhabdomyolysis involves muscle breakdown, presenting with pain, weakness, and dark urine, often with elevated creatine kinase (CK).
• Typical lab findings include hyperkalemia, AKI, and a CK:AST ratio around 20:1.
• Atypical presentations challenge diagnostic norms.

Purpose of the Study:

• To report a case of severe rhabdomyolysis with an unusual laboratory profile.
• To highlight the importance of recognizing rhabdomyolysis in the absence of typical renal and electrolyte abnormalities.

Main Methods:

• Case report of a 26-year-old male after high-intensity functional training.
• Laboratory evaluation including serum CK, AST, ALT, and urinalysis.
• Clinical management with intravenous and oral hydration.

Main Results:

• Extraordinarily high CK (260,100 U/L) and AST (2049 U/L) with a CK:AST ratio of 127:1.
• Presence of myoglobinuria.
• Absence of renal dysfunction or electrolyte abnormalities throughout hospitalization.

Conclusions:

• Severe rhabdomyolysis can manifest without typical laboratory abnormalities, emphasizing the need for clinical suspicion.
• The atypical CK:AST ratio underscores the limitations of relying solely on expected lab patterns.
• Prompt fluid resuscitation and monitoring are crucial for managing rhabdomyolysis, regardless of initial lab findings.