A 28-year-old male presents to the primary care office for evaluation of left calf pain, swelling, and redness. He reports that this started one day ago and worsened today. He ran a 27-mile marathon 2 days ago and traveled for 3 hours in a car today. He reports slight pain on walking and a swollen red calf. He took Ibuprofen 600 mg twice today without relief. Patient reports being an experienced runner, running 3-5 miles daily. He trained for the marathon for 4 months. Patient also reports a history of exercise induced asthma and uses albuterol sulfate HFA as needed.
On physical exam patient appears in good health T 99 P 68 R 18 BP 118/78 wt. 175 lb, height 72 in. BMI 23.1. Heart rate is regular without murmurs, rubs, or gallops. Lungs clear bilaterally. HEENT WNL. Strength lower extremities 5 and DTRs 2. Left calf erythematous, edematous, warm and tender on palpation. Pulses 3 .
Two possible diagnoses were considered: deep vein thrombosis (DVT) and rhabdomyolysis. Stat ultrasound of left leg to rule out DVT was ordered and read as normal CBC WNL Creatine Kinase (CK) 23,000 U/L (normal 24-170 U/L) BUN and Creatinine WNL A diagnosis of rhabdomyolysis was made.
1) What is the pathophysiology associated with this diagnosis? 2) Why do the supplied diagnostic test results support this diagnosis? 3) What are the risks associated with this diagnosis? 4) What type of treatment(s) would assist this patient in alleviating his symptoms?
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