title: Rhabdomyolysis in Dak-Bum devotees: A case series.
abstract: BACKGROUND
  India is a land of culture and heritage always known for its rituals. The devotees offer their prayers in the form of fasting, sacrifices and many other difficult ways to please Almighty! While doing so they often endanger their lives. Rhabdomyolysis, in a particular group of devotees of Bihar/Jharkhand known as Dak-Bum, is a life-threatening clinical entity which occurs in these devotees who travel a long distance in a short period in a fasting state. Rhabdomyolysis detected by myoglobinuria can lead to acute kidney injury and mortality.
  
  
  OBJECTIVE
  To study and identify cases of rhabdomyolysis in devotees (Dak-Bum) and the role of early diagnosis and management.
  
  
  METHODS
  The study was conducted at Ruban Emergency Hospital Patna from August 2010 to August 2013 over 27 patients - 26 males and 1 female of age group 22-34 years. They presented with major symptoms such as dehydration, tender swollen calf muscles and myoglobinuria. The patients were admitted over a period of 2-3 weeks time in a single year (nine patients in 2010, five patients in 2011 and seven patients in 2012 and six patients in 2013). The study was restricted to the month of August every year, as this ritual occurs in a particular season. Inclusion criteria were all previously healthy devotees. The study period was from admission till discharge with daily follow-up of each patient.
  
  
  RESULTS
  Rhabdomyolysis developed in 27 Dak-Bum devotees and all had acute renal failure at the time of admission. RIFLE criteria-StageF(failure) and acute kidney injury network criteria (3rdstage). However, recovery was good due to early intervention in the form of haemodialysis and forced alkaline diuresis by soda bicarbonate infusion.
  
  
  CONCLUSIONS
  Rhabdomyolysis developing in Dak-Bum devotees because of travelling a long distance in a short period, could be managed well due of early diagnosis, timely referral, haemodialysis and forced alkaline diuresis.
authors.affiliation: Department of Emergency, Ruban Emergency Hospital, Patna, Bihar, India.
authors.forename: Sonia
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Nephrology, Ruban Emergency Hospital, Patna, Bihar, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Hans
keywords: Haemodialysis; myoglobin; rhabdomyolysis