What is rhabdomyolysis, the rare condition linked to the death of a 24-year-old NYC marathon runner?
The death of a 24-year-old runner after collapsing during her first marathon in New York has drawn attention to rhabdomyolysis.
Rachel Apa was already near the finish line when the tragedy happened on Nov. 1. According to NBC News, her doctors told her family that she died of the rare muscle condition.
In an interview with PhilSTAR L!fe, ER doctor and health educator Danika Serrano-Pagador said rhabdomyolysis "occurs when damaged muscle tissue breaks down and releases substances such as myoglobin and potassium into the bloodstream.”
“Myoglobin can contribute to acute kidney injury, while excess potassium can cause dangerous, potentially life-threatening heart rhythm disturbances,” she added.
Risk factors and warning signs
Prolonged or unusually intense physical activity can trigger rhabdomyolysis, "particularly when the effort exceeds what the body is accustomed to," per Serrano-Pagador.
Dr. Wesson Pious Espiritu, an orthopedic and sports surgeon, said that extreme exercise "can overwhelm and damage muscle cells, especially when combined with heat, dehydration, or inadequate physical conditioning."
Other risk factors, according to Serrano-Pagador, include infections, excessive alcohol, illicit drug use, and certain medications.
"When they have it, some people may experience nausea, fatigue, or reduced urination," Espiritu told L!fe.
"It may also show in muscle pain that is more severe than expected, muscle weakness, swelling or tenderness, and dark, tea- or cola-colored urine," Serrano-Pagador said.
Recognizing the warning signs is important as they may not appear immediately after the muscle injury.
"Not everyone develops dark urine, so severe muscle symptoms after intense exercise should not be ignored," Espiritu added.
Diagnosis involves blood tests that measure creatine kinase (CK), a marker of muscle injury, as well as tests for kidney function and electrolyte levels, particularly potassium.
“A CK level greater than five times the upper limit of normal or above 1,000 IU/L is commonly used to support the diagnosis,” Serrano-Pagador explained. “Repeat testing may be necessary because CK levels can continue rising after the initial injury.”
Treatment
Treatment depends on the severity of the condition.
"It may involve rest, appropriate fluid intake, and intravenous fluids for patients with more significant muscle injury or risk of complications," said Serrano-Pagador.
Nephrologist Dr. Carlo Boado explained to L!fe how the substances released by damaged muscles can affect the kidneys and cause serious complications.
“Our kidneys act as filters that remove waste products from the blood. During rhabdomyolysis, large amounts of myoglobin are released from damaged muscles and can injure the kidneys, especially when a person is dehydrated,” he said. “In severe cases, this can lead to acute kidney injury, where the kidneys suddenly lose their ability to function properly.”
Per Boado, some patients may require temporary dialysis while their kidneys recover.
Reducing your risk of rhabdomyolysis
There are steps you can take to reduce your risk of developing rhabdomyolysis.
"You can prevent it by gradually increasing exercise intensity, allowing adequate recovery, avoiding exposure to extreme heat, and not doing strenuous exercise when unwell," Serrano-Pagador said.
Adequate hydration may also help, though she noted it doesn't guarantee prevention.
"Stop exercising and seek immediate medical attention if you develop unusually severe muscle pain, weakness, swelling, or dark urine after exercise," she advised.
Espiritu emphasized the importance of proper training and exercise.
“Athletes should only increase exercise intensity gradually and avoid pushing beyond their limits, particularly in hot and humid conditions. Proper training and heat acclimatization are a must,” he said.
Disclaimer: This article is not meant to replace professional medical advice. Always consult your doctor for any questions you may have.