Male, 37 years old, marine, with no relevant morbid history.
He regularly exchanged 6 km and swam long distances without limitations.
When she took part in a mental illness, she wore strengths when she wore a brace, she weighed less than 8 on mental illness and had a lack of generalised strengths.
After that, the unconscious mind presented a convulsive crisis.
She was taken to the emergency service where she was admitted to the hospital with a painful and agitated appearance.
Blood glucose was 48 mg/dl. He received glucose, lorazepan and a phenytoin load.
A computed axial tomography of the brain (without contrast) was normal.
He recovered consciousness in the following hours.
The admission tests, taken three hours after the beginning of the race, showed elevated creatinine with normal uremia, metabolic acidosis with normal lactacidemia, hypernatremia and elevated CK.
She presented red urine, whose sediment showed microscopic hematuria (red cells 8-10 per field).
In the following hours CK and creatinine progressively increased.
A stress LME and a seizure due to hypoglycemia were proposed.
The patient later seated himself, who had only ingested a cup of tea before the beginning of his career and did not regularly use any medication.
During the first day of hospitalization, the patient received saline solution, sodium bicarbonate and glucose obtaining a urine output of 2,180 cc.
The next day, diuresis fell abruptly or in the intensive care unit, where an infusion of furosemide 20 mg/h was instituted, reverting urine.
Although diuresis in the following days was normal, a progressive increase in creatinine was observed up to the sixth day of evolution.
Muscle enzymes reached their peak between the second and third day of the LRM episode, being elevated throughout hospitalization.
An echocardiogram showed normal left ventricular function.
At 18 days of hospitalization, the patient complained of thigh pain, which worsened with a significant increase in muscle enzyme concentrations.
She was discharged 22 days after the onset of LME episode with moderate azotemia and very high CK.
Seven days later, the patient developed progressive physical activity, creatinine levels had risen to 1.7 mg/dl, but muscle enzymes had risen again.
Subsequently, gradually, renal function returned to normal and muscle enzymes decreased.
Two months after discharge, the patient was asymptomatic and developed normal physical activity.
