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Prevention
Military data suggest lowering the risk of exertional rhabdomyolysis can be obtained by engaging in prolonged lower intensity exercise, as opposed to high intensity exercise over a shorter time period. In all athletic programs, three features should be present; (1) emphasizing prolonged lower intensity exercise, as opposed to repetitive max intensity exercises. (2) Adequate rest periods and a high carbohydrate diet replenish glycogen stores. (3) Proper hydration will enhance renal clearance of myoglobin. Also, exercise in above average temperature and humidity can increase risk for exertional rhabdomyolysis. Exertional rhabdomyolysis can be avoided by gradually increasing intensity during new exercise regiments, properly hydrating, acclimatization, and avoidance of diuretics during times of strenuous activity. Sodium bicarbonate supplementation can reduce myoglobin, and prevent exertional rhabdomyolysis. Although sufficient evidence is currently lacking, supplementation with a combination of sodium bicarbonate and mannitol is commonly utilized to prevent renal failure in rhabdomyolysis patients. Sodium bicarbonate alkalizes urine to stop myoglobin from precipitating in renal tubules. Mannitol has several effects including, vasodilatation of renal vasculature, osmotic diuresis, and free radical scavenging.