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Editor,—We wish to report two patients who presented to our accident and emergency department having recently returned from holidays abroad, where they had partaken in “banana boating”, an increasingly popular holiday activity.
A 55 year old man who had been a passenger on a “banana boat” six days previously for approximately 30 minutes, presented with a history of weakness and swelling of both arms for three days. On examination he had gross pitting oedema of both forearms but had a full range of movements of both arms. Urinalysis and serum urea and electrolytes were normal but creatinine phosphokinase (CK) was grossly raised at 4969 IU/l, suggesting considerable muscle damage.
The patient was discharged home with physiotherapy advice, and he made an uneventful recovery.
A 44 year old women who had been a passenger on a “banana boat” two days previously for two hours, presented with a one day history of painful swollen arms. Initially after the ride, she had experienced some tingling and numbness in both hands, which resolved after 24 hours. On examination she had generalised tenderness and noticeable swelling of both arms from the wrists to the shoulders, with limited elbow extension by 45 degrees. Urinalysis tested positive for haemoglobin and protein, and serum urea and electrolytes were within normal limits. Her CK was 9448 IU/l.
Two days later, although her CK had increased to 15 682, she had improved clinically. Her CK after a further two days was 4377 IU/l.
“Banana boats” are large inflatable cylinders pulled behind speedboats, carrying up to eight passengers at a time. Each passenger has a “handlebar” to hold on to in front of them, which must be grasped very tightly in order for them to stay on. The excitement of the ride is heightened by increasing the speed and rate of turn of the speedboat. Rhabdomyolysis, in which muscle fibres are damaged and break down, can result from this form of unusual strenuous physical activity,1 and was diagnosed in both these cases by the combination of the clinical findings and the raised CK levels. When localised to the arms, this can lead to compartment syndrome, a situation where the build up of pressure in the closed fascial compartments of the limbs from trauma or swelling causes an obstruction to the blood supply, and subsequent muscle death. Rhabdomyolysis in its most extreme form can cause metabolic abnormalities leading to acute renal failure and clotting disorders,2,3 which can prove fatal if not treated early.
The manufacturers of commercial “banana boats” recommend a maximum towing speed of 15 miles/hour which is written on the side of the inflatable dingy, but this in practice may often be exceeded to further add to the thrill of the ride. We would suggest that passengers and operators of these craft should be made aware of the possible risks of injury if this speed is exceeded.