Exercise-induced rhabdomyolysis following a swimming session complicated by acute kidney injury: a case report.

INTRODUCTION

Exercise-induced rhabdomyolysis (EIR) is an uncommon but potentially serious condition that can occur after intense or even moderate physical exertion. While EIR is typically linked to strenuous activity or heat exposure, swimming is a rarely reported trigger.

CASE PRESENTATION: A 34-year-old healthy man developed generalized myalgia, dark urine, and vomiting 1 day after a 2-hour swimming session in hot weather. Laboratory tests revealed markedly elevated creatine phosphokinase (250 000 U/L) and acute kidney injury (peak creatinine 14 mg/dL). He received aggressive intravenous hydration, targeting a urine output of 2 mL/kg/hr, with close monitoring. During hospitalization, pulmonary edema due to fluid overload developed, but it resolved with diuretics and oxygen therapy. The patient achieved complete renal recovery without dialysis.

CLINICAL DISCUSSION: EIR can occur even in healthy individuals after moderate exertion. Marked creatine kinase elevation and acute kidney injury are common findings. While early hydration remains the cornerstone of management, excessive fluids may precipitate pulmonary edema, emphasizing careful titration and monitoring.

CONCLUSION

Early, aggressive but goal-directed fluid therapy is vital. Monitoring and promptly treating fluid overload are essential, and even severe biochemical derangements may be managed conservatively when dialysis indications are absent, with multidisciplinary critical care and nephrology input recommended.