Location
Moultrie, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Introduction
Exertional heat injury and rhabdomyolysis are recognized complications of intense physical activity, particularly in environments with elevated temperature and physical stress. Severe skeletal muscle breakdown may result in electrolyte abnormalities, acute kidney injury (AKI), and occasionally compartment syndrome requiring urgent intervention. Although sickle cell trait (SCT) has been considered a benign carrier state, increasing evidence suggests an association with exertional collapse, rhabdomyolysis, and heat-related illness in physically active populations, including military [1,4]. Physiologic stressors such as dehydration, hypoxia, hyperthermia, and metabolic acidosis may promote erythrocyte sickling in individuals with SCT, leading to microvascular obstruction and skeletal muscle ischemia [2]. We present a case of severe exertional rhabdomyolysis complicated by compartment syndrome, dialysis-dependent AKI, and transaminitis in an African American soldier with sickle cell trait following intense military training.
Methods
A retrospective review of the electronic medical record was conducted for a patient admitted to the intensive care unit following exertional heat injury during Army training. Data collected included presenting symptoms, laboratory findings, compartment pressures, imaging studies, and hospital course. Laboratory parameters reviewed included creatine kinase (CK), renal function markers, liver enzymes, and electrolyte abnormalities.
Results
A 30-year-old African American male with known sickle cell trait presented on March 10, 2025, with severe bilateral leg pain following intense physical exertion during military training. Initial evaluation demonstrated profound rhabdomyolysis with creatine kinase levels exceeding 100,000 U/L, severe hepatic injury with AST/ALT levels approaching 8,000 U/L, and acute kidney injury with serum creatinine of 4.7 mg/dL. The patient required urgent hemodialysis, ultimately receiving four dialysis sessions during hospitalization.
Physical examination revealed tense compartments of the lower extremities with pain out of proportion to examination. Interstitial compartment pressure monitoring demonstrated marked elevation of the left lateral compartment pressure at 70 mmHg (range 65–75 mmHg), consistent with compartment syndrome. The patient was managed with urgent surgical evaluation and intensive supportive care, including aggressive intravenous fluid resuscitation and metabolic stabilization.
During hospitalization from March 11–19, 2025, the patient remained in the ICU for management of conditions. Renal function improved following dialysis, and laboratory markers including CK and liver enzymes gradually trended down. The patient was discharged with close outpatient follow-up and temporary medical leave from military duty.
Discussion
This case highlights a potential interaction between sickle cell trait, exertional heat injury, severe rhabdomyolysis, and compartment syndrome. Under conditions of extreme physiologic stress, individuals with SCT may experience episodic erythrocyte sickling leading to microvascular obstruction and impaired skeletal muscle perfusion [1,2]. These mechanisms may amplify exertional muscle injury and contribute to severe rhabdomyolysis and compartment syndrome. Large cohort studies have demonstrated increased risk of exertional rhabdomyolysis among individuals with SCT, particularly in military populations exposed to intense physical stress [4,6]. Recognition of SCT as a potential risk factor for severe exertional complications may facilitate earlier diagnosis and management in high-risk individuals. Further research is needed to clarify whether SCT independently increases susceptibility to compartment syndrome in the setting of exertional heat injury and rhabdomyolysis.
Embargo Period
5-26-2026
Included in
Severe Exertional Rhabdomyolysis and Compartment Syndrome Associated with Sickle Cell Trait Following Heat Injury
Moultrie, GA
Introduction
Exertional heat injury and rhabdomyolysis are recognized complications of intense physical activity, particularly in environments with elevated temperature and physical stress. Severe skeletal muscle breakdown may result in electrolyte abnormalities, acute kidney injury (AKI), and occasionally compartment syndrome requiring urgent intervention. Although sickle cell trait (SCT) has been considered a benign carrier state, increasing evidence suggests an association with exertional collapse, rhabdomyolysis, and heat-related illness in physically active populations, including military [1,4]. Physiologic stressors such as dehydration, hypoxia, hyperthermia, and metabolic acidosis may promote erythrocyte sickling in individuals with SCT, leading to microvascular obstruction and skeletal muscle ischemia [2]. We present a case of severe exertional rhabdomyolysis complicated by compartment syndrome, dialysis-dependent AKI, and transaminitis in an African American soldier with sickle cell trait following intense military training.
Methods
A retrospective review of the electronic medical record was conducted for a patient admitted to the intensive care unit following exertional heat injury during Army training. Data collected included presenting symptoms, laboratory findings, compartment pressures, imaging studies, and hospital course. Laboratory parameters reviewed included creatine kinase (CK), renal function markers, liver enzymes, and electrolyte abnormalities.
Results
A 30-year-old African American male with known sickle cell trait presented on March 10, 2025, with severe bilateral leg pain following intense physical exertion during military training. Initial evaluation demonstrated profound rhabdomyolysis with creatine kinase levels exceeding 100,000 U/L, severe hepatic injury with AST/ALT levels approaching 8,000 U/L, and acute kidney injury with serum creatinine of 4.7 mg/dL. The patient required urgent hemodialysis, ultimately receiving four dialysis sessions during hospitalization.
Physical examination revealed tense compartments of the lower extremities with pain out of proportion to examination. Interstitial compartment pressure monitoring demonstrated marked elevation of the left lateral compartment pressure at 70 mmHg (range 65–75 mmHg), consistent with compartment syndrome. The patient was managed with urgent surgical evaluation and intensive supportive care, including aggressive intravenous fluid resuscitation and metabolic stabilization.
During hospitalization from March 11–19, 2025, the patient remained in the ICU for management of conditions. Renal function improved following dialysis, and laboratory markers including CK and liver enzymes gradually trended down. The patient was discharged with close outpatient follow-up and temporary medical leave from military duty.
Discussion
This case highlights a potential interaction between sickle cell trait, exertional heat injury, severe rhabdomyolysis, and compartment syndrome. Under conditions of extreme physiologic stress, individuals with SCT may experience episodic erythrocyte sickling leading to microvascular obstruction and impaired skeletal muscle perfusion [1,2]. These mechanisms may amplify exertional muscle injury and contribute to severe rhabdomyolysis and compartment syndrome. Large cohort studies have demonstrated increased risk of exertional rhabdomyolysis among individuals with SCT, particularly in military populations exposed to intense physical stress [4,6]. Recognition of SCT as a potential risk factor for severe exertional complications may facilitate earlier diagnosis and management in high-risk individuals. Further research is needed to clarify whether SCT independently increases susceptibility to compartment syndrome in the setting of exertional heat injury and rhabdomyolysis.