Krista and Ken Bragg April 05, 2012 TWEET COMMENTS 2

Warning Signs - Page 3

Ibuprofen (especially in combination with intense exercise and dehydration) has been found to interrupt the kidney’s ability to eliminate damaged muscle bi-products, contributing to rhabdomyolysis. Such nonsteroidal, anti-inflammatory drugs (NSAIDS) have been linked to several high-profile cases of rhabdomyolysis. Prime examples include Diana Finkel (see “Pacing Diana,” June 2011, Issue 73) and Erik Skaggs (see Trail Rx, October 2010, Issue 68). NSAIDS, such as Aleve, aspirin and ibuprofen, have been shown to indirectly alter blood flow in the kidneys, making them more susceptible to the damage created by cell damage and breakdown.

Associations between these medications and exertional rhabdomyolysis are rare and reactions are unpredictable but trail runners beware! If you are taking any medications, discuss your training plan and rhabdomyolysis risks with your health-care provider.

Additional conditions that may predispose athletes for risk of exertional rhabdomyolysis include working out while symptomatic with a viral illness or bacterial infection, endocrine problems, electrolyte imbalances, sickle-cell disease and rare conditions such as malignant hyperthermia or neuroleptic syndrome. In trail runners’ terms, going for a personal record or running your first ultramarathon while sick with the flu may put you at risk for exertional rhabdomyolysis. Other vulnerable situations include training or racing while dehydrated, in extreme heat or in prolonged states of hypothermia.

What Are the Signs?
The classic triad of symptoms associated with rhabdomyolysis includes muscle pain, general weakness and decreased or very concentrated urine. While almost half of those affected experience extremely dark urine (resembling cola), not everyone experiences weakness and pain.

Other symptoms may include some or all of the following: fast heart rate, elevated body temperature and vomiting. Symptoms may take up to 24 to 48 hours after exercise to reveal themselves (Cervellin G et al 2010). The diagnosis is made by health-care professionals after taking a blood test that measures creatine kinase—a kidney-function marker. Other lab tests will reveal any electrolyte abnormalities or, in extreme cases, the beginnings of organ damage to your heart or kidneys.

“Athletes should look for these warning signs: decreased urination, dark urine, fever, vomiting, joint and muscle pain and confusion,” advises Dr. Bilik. “If warning signs are present, stop exercising and seek prompt medical treatment with re-hydration and possibly diuretic therapy.” Evaluation of electrolyte balances may be warranted as well. In extreme cases, kidney dialysis may be necessary, and typically occurs in situations in which warning signs were unnoticed or ignored prior to medical intervention.

Treating Rhabdomyolysis
Many athletes weigh themselves before and immediately after training to evaluate total fluid losses vs. replacement during training events. Weight changes can be used to determine generalized fluid replacement. For athletes desiring a more individualized and scientific approach, formulas have been created to determine individual sweat rates and fluid replacement, and are readily found online. Because different athletes have differing sweat and energy-expenditure rates, it is impossible to provide a single recipe that applies to all runners.


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