Dehydration, cramping, and exertional rhabdomyolysis: A case report with suggestions for recovery

Objective: We present a case of severe dehydration, muscle cramping, and rhabdomyolysis in a high school football player followed by a suggested program for gradual return to play. Background: A 16-year-old male football player (body mass = 69.1 kg, height = 175.3 cm) reported to the ATC after the morning session on the second day of two-a-days complaining of severe muscle cramping. Differential Diagnosis: The initial assessment included severe dehydration and exercise-induced muscle cramps. The differential diagnosis was severe dehydration, exertional rhabdomyolysis, or myositis. CK testing revealed elevated levels indicating mild rhabdomyolysis. Treatment: The emergency department administered 8 L of intravenous (IV) fluid within the 48-hr hospitalization period, followed by gradual return to activity. Uniqueness: To our knowledge, no reports of exertional rhabdomyolysis in an adolescent football player exist. In this case, a high school quarterback with a previous history of heat-related cramping succumbed to severe dehydration and exertional rhabdomyolysis during noncontact preseason practice. We provide suggestions for return to activity following exertional rhabdomyolysis.