A 22-Year-Old Football Player Who Collapsed Has Urine Changes

Faizah Siddique, MD; Herbert S. Diamond, MD


November 01, 2022

Physical Examination and Workup

The patient is examined in the emergency department approximately 1 hour after the episode. His vital signs include a temperature of 99.5°F (37.5°C), a blood pressure of 116/74 mm Hg, and a heart rate of 110 beats/min. His weight is 250 lb (113.4 kg), and his height is 6 feet 2 inches (1.88 m). He is muscular but has obesity. He is in no discomfort. He has a regular heart rhythm, and no murmurs or bruits are auscultated.

The patient's lung and abdominal examination findings are normal. His cranial nerves are intact. His proximal upper-extremity muscle examination reveals bulky muscles with 4/5 strength; the remainder of his examination findings are normal. His muscles are tender and doughy. He has normal sensation to light touch, pinprick, cold, and vibration. His deep tendon reflexes are 2+. Finger-to-nose test findings are normal. The Romberg sign is negative. His gait is normal. His neuromuscular examination findings are otherwise normal.

Initial laboratory test results reveal a hemoglobin level of 14.5 g/dL (reference range, 13.8-17.2 g/dL), a hematocrit of 49% (reference range, 41% to 50%), and a white blood cell count of 11,200/mcl (reference range, 4,500-11,000/mcl), with 72% neutrophils and no bands. A renal electrolyte panel reveals a creatinine level of 1.7 mg/dL (reference range, 0.7-1.3 mg/dL), a sodium level of 135 mmol/L (reference range, 135-145 mmol/L), and a potassium level of 4.9 mmol/L (reference range, 3.6-5.2 mmol/L). His creatin phosphokinase level is 12,976 IU/L (reference range, 20-200 IU/L). The remainder of his basic metabolic panel findings, including calcium, magnesium, and phosphorus levels, are normal.

The urinalysis is positive for blood, but no red cells are found. Urine drug screen results are negative. The patient's urine is dark (Figure).


CT of the head and MRI of the brain are both normal. An ECG is notable for sinus tachycardia. The EEG findings are normal. Electromyography and nerve conduction study findings are normal.


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