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How to do it: investigate exertional rhabdomyolysis (or not)
  1. Peter M Fernandes1,
  2. Richard J Davenport2
  1. 1 Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
  2. 2 Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
  1. Correspondence to Peter M Fernandes, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SA, UK; peterfernandes{at}


Rhabdomyolysis is the combination of symptoms (myalgia, weakness and muscle swelling) and a substantial rise in serum creatine kinase (CK) >50 000 IU/L; there are many causes, but here we specifically address exertional rhabdomyolysis. The consequences of this condition can be severe, including acute kidney injury and requirement for higher level care with organ support. Most patients have ‘physiological’ exertional rhabdomyolysis with no underlying disease; they do not need investigation and should be advised to return to normal activities in a graded fashion. Rarely, exertional rhabdomyolysis may be the initial presentation of underlying muscle disease, and we review how to identify this much smaller group of patients, who do require investigation.

  • myopathy
  • McArdle’s disease
  • metabolic disease
  • muscle disease
  • phosphofructokinase

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  • Contributors The two authors are justifiably credited with authorship, according to the authorship criteria. All authors fulfil ICMJE criteria including: (1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published. PMF will act as guarantor for the content.

  • Funding PMF funded by Wellcome Trust (grant number 106359).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Provenance and peer review. Commissioned. Externally peer reviewed by David Hilton-Jones, Oxford, UK.

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