Weak, tender and sore muscles. Williams E S, Thorne T (1996)Exertional myopathy.In: Fairbrother A, Locke LN, Hoff GL (eds).Non-infectious diseases of wildlife.2nd Ed. If a horse has refused water due to being tied up, he/she requires IV fluids to replace lost hydration. An Arabian endurance horse quits at the 25 th mile, trembling at the top of a hill. A number of horses, predominantly fillies, have recurrent episodes of rhabdomyolysis (muscle cramping) with even light exercise. Myosin-heavy chain myopathy (MYHM) is a muscle disease that results in two distinct clinical disease presentations, immune-mediated myositis and non-exertional rhabdomyolysis.The specific genetic mutation associated with risk for MYHM is in the MYH1 gene and was first identified in horses with immune-mediated myositis or IMM and is why initially the DNA test was named IMM. During an episode, horses are reluctant to move, experience pain, stiffness, and tremors, and sweat profusely. This rare condition occurs when muscle cells burst and leak their contents into the bloodstream. 1. Young foals are even more at risk for these toxicities. If this theory has some truth to it, then rapid alleviation of symptoms … New study on tying-up in horses and ponies. This article focuses on the treatment of Tying-up … Horses can lie down and have difficulty rising due to severe muscle pain. As the name suggests it commonly happens when horses are working at speed and so is most commonly seen in Thoroughbreds, Standardbreds and Arabs. Exertional rhabdomyolysis (ER) is the most accurate name for the condition that causes the dissolution (breakdown) of muscle cells following exercise. The clinical signs manifesting during or after exercise resemble other types of exertional rhabdomyolysis. If you have additional questions or need assistance with logging in, contact us at (859) 233-0147 or aaepoffice@aaep.org. 1999b;30:533-538. Iowa State Press, Ames, Iowa. Horses that tie-up are reluctant to move due to muscle stiffness, muscle cramping, and muscle pain (myalgia). However, diet may have a calming effect on Thoroughbred horses with RER as manifested by decreased pre-exercise heart rates and decreased pre-exercise PCV in horses fed the fat diet. Methocarbamol is a muscle relaxant that can be used in equines to treat symptoms associated with Rhabdomyolysis. Laminitis in Horses – What Causes It, Symptoms and Treatment. Gait abnormalities. Tying-up most commonly occurs when a There are two main types of exertional rhabdomyolysis, Sporadic and chronic. This can cause an array of problems including weakness, muscle soreness, and dark or brown urine. Exertional rhabdomyolysis has several causes. These clinical signs are not unique to exertional rhabdomyolysis and may be seen in horses with severe thoracolumbar discomfort associated with impinging dorsal spinous processes, pain associated with the sacroiliac joints, or bilateral hindlimb lameness. Over the past century, a number of terms have been used to describe this syndrome including tying up, set fast, Monday morning disease, azoturia, chronic intermittent rhabdomyolysis, and equine-rhabdomyolysis syndrome. Exertional rhabdomyolysis (ER) is the most accurate name for the condition that causes the dissolution (breakdown) of muscle cells following exercise. J., Suppl. This article considers the clinical signs, occurrence, pathophysiology, diagnosis, treatment, prevention, and prognosis associated with PSSM as a cause of exertional rhabdomyolysis in horses. Equine exertional rhabdomyolysis (Tying UP) in horses – the horse immediately needs to stop moving 04/03/2013 by Marie 1 Comment This is the nightmare of every rider: The horse suddenly walks in a stiff way, has muscle tremors and attacks of sweating. Nonexertional rhabdomyolysis, or “tying up not caused by exercise”, is characterized by severe muscle pain, stiffness and reluctance to move. Rhabdomyolysis in foals and exertional myopathies in adult horses do not usually damage the basement membrane, thus complete repair of muscle tissue is possible within 4 - 8 weeks. Overview of Myopathies in Horses. Acta vet. CK and AST may be normal in draft horses with this syndrome. This is also known as Azoturia, Monday Morning Sickness, Tying - Up and Set Fast and it affects the horses muscles causing them to harden and cramp up, it can vary in its severity from mild cramps to the horse being unable to move. 30 (1999) 533-538 533 Exertional rhabdomyolysis in Quarter Horses and Thoroughbreds: one syndrome, multiple aetiologies STEPHANIE J. VALBERG*, J. R. MICKELSONt, ESTHER M. GALLANT*, JENNIFER M. MAcLEAY, LINNEA LENTZt and F. DE LA CORTE Department of Clinical and Population Sciences and tDepartment of Veterinary … The main signs of rhabdomyolysis include: Muscle swelling. What are the Symptoms of PSSM in Horses? However, this trio of symptoms is present in less than 10% of all people with rhabdomyolysis. Muscle disorders in horses present with a variety of clinical signs ranging from muscle stiffness and pain to muscle atrophy, weakness, exercise intolerance, and muscle fasciculations. Hypocalcemic tetany in horses is an uncommon condition associated with acute depletion of serum ionized calcium and sometimes with alterations in serum concentrations of magnesium and phosphate. Broad etiologies include: traumatic, non-traumatic exertional, and non-traumatic non-exertional. Affected animals may appear dehydrated, painful, weak, disoriented, and nauseous. We suggest considering Alam, Re-Leve or Low Starch, depending upon what is available in your area. This is also known as Azoturia, Monday Morning Sickness, Tying - Up and Set Fast and it affects the horses muscles causing them to harden and cramp up, it can vary in its severity from mild cramps to the horse being unable to move. Horses with ER usually show signs of muscle stiff-ness, shifting hindlimb lameness, elevated respira-tory rate, sweating, firm painful hindquarter muscles, and reluctance to move that lasts for sev-eral hours. polysaccharides within skeletal muscle. A second syndrome, termed non-exertional rhabdomyolysis or “tying-up not associated with exercise”, presents with some similar symptoms, but affected horses may or may not have muscle atrophy, and there is often no evidence of lymphocytes in the muscles. If the kidney is ill harmful substances stay in the organism and other organs get damaged. Exertional rhabdomyolysis (ER), literally the dissolution of striated muscle with exercise, is an age-old problem in horses. All hard-working horses require 1 to 2 oz. A horse show classic signs of ER; pain, stiffness, sweating and reluctance to move. 7, 8 and 9) Ultrastructural changes at this time were dominated by a broadeningof the subsarcolemmicspacein singlefibres or groups Inherited abnormalities cause chronic forms of exertional rhabdomyolysis. Equine Rhabdomyolysis. There may be tea-colored urine or an irregular heartbeat. If a horse shows signs of ER a veterinarian will determine how severe the problem is, relieve the muscle pain and cramping, provide oral or intravenous fluids to correct dehydration and flush myoglobin from the kidneys and put a management plan in place. Polysaccharide Storage Myopathy (PSSM): Exertional Rhabdomyolysis. Muscle disorders in horses present with a variety of clinical signs ranging from muscle stiffness and pain to muscle atrophy, weakness, exercise intolerance, and muscle fasciculations. Rhabdomyolytic attacks can happen to any animal or person after extreme or unaccustomed exercise, but it is most commonly diagnosed in racehorses. Horses that tie-up are reluctant to move due to muscle stiffness, muscle cramping, and muscle pain (myalgia). Some of the muscle breakdown products, such as the protein myoglobin, are harmful to the kidneys and may lead to kidney failure. Equine polysaccharide storage myopathy (EPSM, PSSM, EPSSM) is a hereditary glycogen storage disease of horses that causes exertional rhabdomyolysis.It is currently known to affect the following breeds American Quarter Horses, American Paint Horses, Warmbloods, Cobs, Dales Ponies, Thoroughbreds, Arabians, New Forest ponies, and a large number of Heavy horse breeds. EQUINE EXERCISE PHYSIOLOGY 5 Equine vet. pp. Equine exertional rhabdomyolysis (ER), often referred to as “tying-up”, is a clinical syndrome characterized by painful muscle contractures with exercise and skeletal muscle fiber necrosis. Rhabdomyolysis. Signs of a severe bout of ER may include: reluctance to move, sweating, elevated heart and respiratory rates as a result of the pain, anxious expression, shifting of weight from side to side, standing hunched and tense, passing reddish-brown urine, dehydration, shock, and inability to rise. Symptoms of Rhabdomyolysis. Exertional rhabdomyolysis is a common muscle disorder related to exercising horses and equine athletes and involves painful constriction or cramping of the muscles during and after activity or exercise. The kidney is the organ which detoxifies the body. Causes of Equine Rhabdomyolysis. While the term ‘tying up’ does a good job of describing the key symptoms of PSSM and many other muscle disorders, research is moving away … Methocarbamol is available as a solution for injection but is not commercially available as an oral suspension. Genes linked to rhabdomyolysis are found in draft horses and draft mules, but any horse can develop the problem. It is a clinical syndrome which occurs when horses exercise, resulting in painful muscle contractions and necrosis of the skeletal muscle fibers. The condition can present as a one-time acute onset of symptoms or can reoccur chronically. It occurs after prolonged physical exertion or transport (transport tetany) … This article presents a brief description of what is known about the cause and pathogenesis of chronic intermittent rhabdomyolysis in horses. The three classic symptoms of rhabdomyolysis are muscle pain, weakness, and reddish-brown urine (caused by the high levels of the red-pigmented protein myoglobin that is dumped into the blood). Tying-up (exertional rhabdomyolysis) is also a common precursor to acute kidney failure. ", The scientific name for Tying up is rhabdomyolysis, which simply translated means muscle (myo) breakdown (lysis). The disorder is also sometimes known as tying up, azoturia, setfast, monday-morning disease or just rhabdomyolysis. Equine polysaccharide storage myopathy (EPSM) is a form of rhabdomyolysis classified as a metabolic disease that results in the accumulation of high muscle glycogen and abnormal polysaccharide in skeletal muscles. Causes of Equine Rhabdomyolysis. In addition to strangles, IMM and non- exertional rhabdomyolysis can also be triggered by anything that causes inflammation in the muscle that would expose the fibers to the immune system, such as a vaccine reaction. scand. title = "Diagnosis and management of equine rhabdomyolysis", abstract = "Our knowledge of rhabdomyolysis has increased greatly in the past 10 years. Briony Witherow explains the importance of correct nutrition when managing a horse that 'ties up'. During these episodes, muscles become damaged and unable to function properly. after the onset of acute symptoms (Figs. When abnormal alterations occur in the physiology of muscles, a horse may experience painful, uncontrollable, and continuous muscle contractions. Rhabdomyolysis is a clinical syndrome involving the breakdown of skeletal muscle tissue. The main objective of the subject is the knowledge of the basis and main techniques of the veterinary anesthesia, and let the development of a critical knowledge related to another clinical sciences. The most common clinical presentation is muscle pain, stiffness, and reluctance to move due to rhabdomyolysis. Any horse with the suspected disease myoglobinuria or rhabdomyolysis should be admitted for prompt intravenous hydration. The disorder is also sometimes known as tying up, azoturia, setfast, monday-morning disease or just rhabdomyolysis. It comes on extremely rapidly during exercise and essentially renders the horse unable to move. In a patient working outdoors, it is appropriate to consider the horse when seeing the hoof-prints of rhabdomyolysis. Myoglobinuria and recumbency are rare. Myofibrillar Myopathy (MFM) is a form of exercise intolerance. The other common signs are: Stiffness of legs. Acute symptoms are an unwillingness to move and muscle damage following exercise. — Morphological, biochemical and histochemical changes were studied in muscle needle biopsy specimens (gluteus medius) from 59 standardbred trotters with acute clinical symptoms of the “tying-up” disease. Symptoms may include muscle pains, weakness, vomiting, and confusion. There may be a decrease in the severity of clinical signs as horses get older.3,4 Subclinical episodes occur in some horses, causing decreased A Quarter Horse ranch horse is stymied by progressive weight loss and decreased performance. Specific Causes of Chronic Exertioal Rhabdomyolysis. Veterinary Anesthesia and Reanimation. Weak, tender and sore muscles. Clinical signs in draft horses may include loss of muscle mass, progressive weakness, and recumbency. Non-Exertional Rhabdomyolysis . The damage can be so severe that it may lead to kidney injury. Diagnosis and Treatment of Rhabdomyolysis in Foals We hear a lot about a horse experiencing rhabdomyolysis (tying-up) during or after exercise. 3. Non-exertional rhabdomyolysis (NER) has clinically similar symptoms that are brought on by causes other than exertion. Dark urine that is brown, red or tea-colored. Shortened stride. New study on tying-up in horses and ponies. These horses increase their fat stores, and those at risk for developing equine metabolic syndrome typically develop regional adiposity (e.g., cresty neck, fat pads at the tailhead). Exertional rhabdomyolysis refers to extreme muscle damage that occurs as a result of short, high-intensity workouts. Reasons for performing study: Dantrolene sodium (Dantrium) has been used extensively for the treatment of myopathies in man and anecdotal evidence suggests it is of clinical benefit in the control of exercise-induced rhabdomyolysis (ER) in racehorses, although data to support this are currently lacking. The main signs of rhabdomyolysis include: Muscle swelling. Equine Exertional Rhabdomyolysis. This study was designed to gather information on the influence of dietary starch, fat, and bicarbonate on recurrent exertional rhabdomyolysis. Recurrent Exertional Rhabdomyolysis (RER) is a form of exercise intolerance. of plain salt daily, plus an electrolyte balanced to sweat … Polysaccharide Storage Myopathy (PSSM) is a glycogen storage disorder in which affected horses have chronic episodes of exertional rhabdomyolysis (“tying-up”). Tying up, or Exertional Rhabdomyolysis, in horses is characterized by muscle pain, stiffness, excessive sweating, and a reluctance to move associated with exercise. Rhabdomyolysis is so common it has several names: Monday Morning Disease, Equine Polysaccharide Storage Myopathy (EPSM), and shivers. What is Tying Up in Horses? While horses with rhabdomyolysis are not lame, they walk stiffly and in pain. Overview of Myopathies in Horses. Symptoms usually develop one to three days after the muscle injury, though some people may not even notice muscle soreness. Horses were exercised on a treadmill daily for 3 wk/treatment with a 2-week washout period between treatments. LINDHOLM, A., H.-E. JOHANSSON & P. KJÆRSGAARD: Acute rhabdomyolysis (“tying-up”) in standardbred horses. Most cases of rhabdomyolysis in the horse are diagnosed not only on presenting clinical signs such as stiffness, tight muscle groups, and discolored urine, but also through the use of blood work testing. A Thoroughbred racehorse acts colicky returning to his stall after a morning workout. For horses prone to tying-up, a reduced carb diet is wise. And at least one alphabetic character. Exertional rhabdomyolysis (ER), literally the dissolution of striated muscle with exercise, is an age old problem in horses. … Detailed clinical and molecular investigations are starting to uncover and identify more diverse disorders that lead to a clinical end-point that represents signs of muscle disease. 1974, 15, 325–339. Dark urine that is brown, red or tea-colored. It is a frequent cause of exertional rhabdomyolysis in horses, accounting for 40 per cent of neuromuscular disease in certain populations, and is particularly common in quarter horse, draught and warmblood breeds, together with their crosses. The clinical signs manifesting during or after exercise resemble other types of exertional rhabdomyolysis. When abnormal alterations occur in the physiology of muscles, a horse may experience painful, uncontrollable, and continuous muscle contractions. If a horse is exhibiting symptoms of Exertional rhabdomyolysis, a visit to the veterinary clinic is usually in order. Methocarbamol is available as a solution for injection but is not commercially available as an oral suspension. Signs: the acute clinical signs for exertional rhabdomyolysis, whether sporadic or recurrent, are similar and consist of muscle stiffness, shortened hind limb gait, reluctance to move, firm painful muscles particularly in the hindquarters and lower back, anxiety, pain, sweating and increased respiratory rate. Rhabdomyolysis in equines occurs in horses due to physical overexertion or underlying pathologic myopathy. Symptoms and signs include muscle weakness, myalgias, and reddish-brown urine, although this triad is present in less than 10% of patients. In addition, the most important factors in preventing rhabdomyolysis apparently include pasture turn-out and daily exercise. The clinical signs manifesting during or after exercise resemble other types of exertional rhabdomyolysis. Valberg S (1997)Exertional Rhabdomyolysis in the Horse.Kentucky Equine Research Inc., Equine Nutrition Conference, (1997). Clinically applicable diagnostic tests and published results in affected horses, prophylaxis, and treatment of … RER (recurrent exertional rhabdomyolysis) is witnessed in several horse breeds, which includes Paints, Quarter Horses, Thoroughbreds, Appaloosas, Standardbreds, Arabians, and Morgans. Recurrent Exertional Rhabdomyolysis (RER) refers to a type of muscle disease that occurs in sport horses, that is actually a subset of recurring "tying-up" episodes. The urine may be brown in color … Serum CK activity was measured daily 4 hours after exercise. Rhabdomyolysis is a condition in which damaged skeletal muscle breaks down rapidly. Recurrent Exertional Rhabdomyolysis. Sporadic episodes stem from muscle strain, overtraining and electrolyte or dietary deficiencies. Rhabdomyolysis in horses 329 Electron microscopy, 1-4hrs. Chronic Exertional Rhabdomyolysis. This article focuses on the treatment of Tying-up … Equine Rhabdomyolysis. 181-193. History and clinical signs: There is a lot of variation in the severity of clinical signs and these do not always. This condition is called tying-up, or rhabdomyolysis, and is comparable to severe cramps that a human might experience. Recurrent exertional rhabdomyolysis (RER) in horses is an exercise-associated disease that involves repeated episodes of muscle damage. What are the symptoms of PSSM in horses? Once the equine disease myoglobinuria is determined prompt fluid rehydration aids in the initial control of myoglobinuria. Horses presented with overnutrition on a regular basis may become obese or exacerbate existing obesity, especially when coupled with limited physical activity. • In some horses displaying recurrent signs treatment with drugs that modify release of calcium from the muscle cells may be beneficial Please contact a member of our equine veterinary team on 01332 294929 if you require any further information or if you think your horse may be showing signs of the condition. Rhabdomyolysis Signs and Symptoms. Recurrent Exertional Rhabdomyolysis (RER) RER is the term used to describe horses that have an abnormal process of muscle contraction. Firm musculature. Indeed horses do not often have an inflammation of the kidney. Equine Rhabdomyolysis (Tying up) November 25, 2013 by Milbourn Equine Vets. Exertional rhabdomyolysis in Quarter Horses and Thoroughbreds; one syndrome, multiple etiologies. During an episode, horses are reluctant to move, Signs and symptoms of rhabdomyolysis may be hard to pinpoint. Equine Rhabdomyolysis (Tying up) by Reuben Whittaker BVSc MRCV. 18 Jan. We may earn money or products from the companies mentioned in this post. Recurrent exertional rhabdomyolysis (RER) is seen in many breeds of horses including Quarter Horses, Paints, Appaloosas, Thoroughbreds, Arabians, Standardbreds, and Morgans. Streptococcus equi Rhabdomyolysis Severe rhabdomyolysis can occur in horses with Streptococcus equi equi submandibular lymphadenopathy and/or guttural pouch empyema. Treatment should include IV oxytetracycline and supportive care. Horses that develop NER have a genetic component that may predispose them to developing this disease when triggered by certain environmental stimuli. Symptoms usually develop one to three days after the muscle injury, though some people may not even notice muscle soreness. Horses with muscle disease can have several clinical signs (symptoms) including:Tying-up (rhabdomyolysis). The condition is known as exertional Rhabdomyolysis. Horses with muscle disease can have several clinical signs (symptoms) including:Tying-up (rhabdomyolysis). Firm, swollen and painful back and rump muscles Stiff gait and reluctance to move Difficulty rising Rapid heart … Exertional Rhabdomyolysis, Tying-up, Azoturia, Monday Morning Sickness and Poly Saccharide Storage Myopathy are all names of common muscle metabolism problems. Equine Exertional Rhabdomyolysis Syndrome (ERS) or Tying Up in Horses Equine Exertional Rhabdomyolysis Syndrome (ERS), also known as azoturia or, more colloquially, “tying up”, is a condition that affects the muscles of the horse. Introduction. A Quarter Horse ranch horse is stymied by progressive weight loss and decreased performance. An Arabian endurance horse quits at the 25 th mile, trembling at the top of a hill. During an episode, horses are reluctant to move, experience pain, stiffness, and tremors, and sweat profusely. Rhabdomyolysis remains an important cause of morbidity and mortality in horses. WHAT ARE THE CLINICAL SIGNS? The treatment of burn induced rhabdomyolysis presents a great challenge because burn treatment itself requires vigorous fluid overload, thus making it difficult to add more fluids for rhabdomyolysis management86. Horses in renal failure are depressed and lack appetite. The causes are several but the result is the same, muscle cramping. Clinically myalgia and dark urine are common presenting symptoms with elevation in CK and myoglobin. Known as “rhabdo” for short, it can affect humans as well as horses and can happen during or immediately following exercise. Recurrent exertional rhabdomyolysis (RER) in horses is an exercise-associated disease that involves repeated episodes of muscle damage. Tying up syndrome is a preferable name to exertional rhabdomyolysis because not all horses that tie up have exercised, writes Dr Robert N Oglesby, DVM. This condition is called tying-up, or rhabdomyolysis, and is comparable to severe cramps that a human might experience. The password requirements are: Seven characters minimum length. Valentine BA, Hintz HF, Freels KM et al. Known as “rhabdo” for short, it can affect humans as well as horses and can happen during or immediately following exercise. Horses with a kidney disease: symptoms, diagnosis, treatment. Exertional rhabdomyolysis (tying up) is a serious condition that may cause long term damage if treatment isn't sought fast. rhabdomyolysis, indicated by CK activity, or on the metabolic response to exercise. Myofibrillar Myopathy (MFM) is a form of exercise intolerance. Over the past century a number of terms have been used to describe this syndrome including tying-up, set fast, Monday morning disease, azoturia, chronic intermittent rhabdomyolysis and equine rhabdomyolysis syndrome. The most common clinical presentation is muscle pain, stiffness, and reluctance to move due to rhabdomyolysis. NSAIDs like bute and flunixin (Banamine) when given in excess, can cause renal failure in the horse. The most common signs of PSSM in horses are “tying up” like symptoms due to excessive deposition of glycogen in the muscle cells. Thoroughbred horses are particularly susceptible to ER, with 5-10 % of all Thoroughbreds developing ER during a racing season. The episodes may occur once or twice a year to every time the horse is exercised. Tied up horses … In horses with herpes or the flu, too much exercise can bring on an episode of sporadic exertional rhabdomyolysis. Introduction Exertional rhabdomyolysis is the most common equine myopathy Psychologically horses can be affected by the association of work creating pain, the memory of a recent episode could result in the horse working in a tense profile, almost waiting for that onset of pain. Initial treatment prevents the precipitation of myoglobin in the urine by inducing diuresis. “In these horses, it mistakes the myosin protein for strangles protein, and it attacks its own muscles,” she said. To determine the likely mode of inheritance and identify probable foundation horses for recurrent exertional rhabdomyolysis (RER) in Thoroughbred (TB) racehorses. And at least one numeric character. 4 families of TB racehorses with a high prevalence of RER, consisting of 3 to 53 horses/family, were used to determine mode of inheritance. Methocarbamol is a muscle relaxant that can be used in equines to treat symptoms associated with Rhabdomyolysis. Equine Exertional Rhabdomyolysis. In very dangerous cases it even refuses any further kind of movement. Rhabdomyolysis in equines occurs in horses due to physical overexertion or underlying pathologic myopathy. Uncategorized. Streptococcus equi Rhabdomyolysis Severe rhabdomyolysis can occur in horses with Streptococcus equi equi submandibular lymphadenopathy and/or guttural pouch empyema. Recurrent exertional rhabdomyolysis, also called tying-up syndrome, refers to the severe muscle cramping and cellular damage seen in some exercising horses. A Thoroughbred racehorse acts colicky returning to his stall after a morning workout. Rhabdo is short for rhabdomyolysis. Regardless of the initial cause, late onset Rhabdomyolysis could occur due to immobilization or circumferential burns contractures. The medical term for tying-up is rhabdomyolysis that refers to physical damage and destruction of skeletal muscle cells. Polysaccharide Storage Myopathy (PSSM) or, more commonly referred to as ‘tying up’, is a clinical issue affecting the muscle function in horses. During these episodes, muscles become damaged and unable to function properly. Laminitis, commonly known as founder, is a painful disease that causes severe lameness in horses. Dietary control of exertional rhabdomyolysis in horses J Am Vet med Assoc 1998b;212:1588-1593. It can often cause lameness in two, or all four feet at one time, but it is preventable. When draft horses develop rhabdomyolysis, CK and AST may be markedly increased, and horses can become myoglobinuric, weak, and reluctant to rise. International Conference on Equine Exercise Physiology Equine Vet J Suppl. Treatment should include IV oxytetracycline and supportive care. This is largely true because the course of rhabdomyolysis … Tying-up most commonly occurs when a The medical term for tying-up is rhabdomyolysis that refers to physical damage and destruction of skeletal muscle cells. A morphological and biochemical study.
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