This is part two of our series of understanding rhabdomyolysis in athletes. First we covered the basics on what you, as someone who works out, needs to know about the causes of rhabdo and the complications of rhabdo. This week we’re covering rhabdomyolysis prevention and treatment.

Rhabdomyolysis Summary

In cause you missed part one on our rhabdomyoylis series, here’s a quick breakdown of what rhabdo is. For a further breakdown, see our past post.

Rhabdomyolysis: Rhabdomyolysis can be caused by many different factors but specifically we’re looking at exertional rhabdomyolysis in athletes. Rhabdomyolysis in athletes can be caused by all or one of these factors: inadequate carbohydrates, electrolyte imbalances, excessive heat, drugs or alcohol, or dehydration.

Rhabdomyolysis happens under extreme exertion when energy supply can no longer meet the demand. When this happens, your muscles begin to breakdown. As the muscle tissue breaks down, it releases muscle byproducts which are excreted by the kidneys. The only problem is, these that these broken down muscle proteins are toxic to the kidney. Worst case scenarios can include kidney failure which requires emergent dialysis, to surgery on affected limbs to relieve pressure caused by swelling to the areas.

Rhabdomyolysis Prevention

Rhabdomyolysis can be potentially fatal and it’s something every athlete needs to be aware of. In a nutshell, the mantra that proper planning prevents poor performance holds true when it comes to rhabdo prevention.

Physical Activity:

Acclimate yourself accordingly. Nobody runs a marathon the first day. Nobody also shows up to a football camp the first day expecting to play like it’s the Superbowl. You need to tailor your workouts in steps, gradually increasing your muscular endurance and cardiovascular endurance in phases.

Feed Yourself Accordingly:

Your body can be as a machine if the right factors are present. Your cells love a good balance of sodium and potassium to function. Without these essential electrolytes your body’s cell metabolism starts to malfunction. For vigorous exercise it’s important to hydrate with electrolytes before, during, and after. Carbohydrates are also essential to your body’s metabolism during intense activity. During intense bouts of physical activity, muscles can run out of their nutrients. Failure to provide the energy to for muscles to be able to contract can lead rhabdomyolysys.

Water:

Water is great. Dehydration is your kidneys worst enemy. On the flip side, hydrating yourself with just water doesn’t do your body any good either. Too much water without electrolytes can actually dilute your blood, dropping your electrolyte levels and wreak havoc on your body. It also goes without saying, avoid drugs (alcohol, cocaine, amphetamine, heroin, etc.) as substance abuse has been linked with rhabdomyolysis.

Know Your Climates:

Hot and humid climates are more likely to cause rhabdomyolysis for the simple fact that those climates cause your body to heat up and lose more fluid and electrolytes through sweat. Be aware of your climate. If you come from Denver in the winter and go to Miami, your body needs to adjust to the environment. Scale your workouts down accordingly.

Clothing is also another factor. Loose, light clothing allows heat to dissipate better from your body and allows for better cooling. Lighter colored clothing also absorbs less heat from the sun than darker clothing.

Rhabdomoylysis Treatment

Because not all cases of rhabdomyolysis are associated with reddish brown urine, some people might not even know they have it. More than likely, rhabdomyolysis is underdiagnosed in the athletic populations as many people might not even be aware they have a mild case of rhabdo. In any sense, it goes without saying, use common sense after any vigorous exercises which would include:

1. Carbohydrates: you need some to replenish your glycogen stores. Especially if you plan on exercising again within the next twenty-four to forty-eight hours.
2. Fluid. Fluid. Fluid.
3. Electrolytes. You need salt and potassium to replenish that which was lost during sweat through high levels of activity. Your cells thrive on it.
4. Avoid drugs and alcohol.
5. Allow your body proper time to rest. Muscle, like bone, takes time to heal if it’s damaged. If you go out and kill your legs one day, ease up on leg exercises for the next couple of days.

Last of all: be familiar with the signs and symptoms of rhabdomyolysis.

Hospital Treatment Of Rhabdomyolysis

If you’re one of the unlucky ones who have made it as an admission to the hospital, chances are you have a pretty bad case (if not acute kidney failure).

If that’s the case, aggressive IV fluid replacement is the gold standard. If any electrolyte levels are off such as potassium or sodium, those will be addressed with medications as well. You can expect to have your urine and blood collected routinely to be sent off and analyzed in the lab to see if your conditions are resolving. How much fluid should one be taking in? No research has really been conducted in this area, but generally in a hospital setting, fluid is given until optimal urine output (200-300ml per hour) is achieved and your kidney lab work starts looking better.

Under renal failure your body can also quickly become acidic. High levels of acid in the body are never a good thing. Sometimes a medication called sodium bicarbonate is given through an IV to help correct your acidity levels.

Worst case scenario: Dialysis

If your case of rhabdo is so severe, your kidneys can temporarily shut down completely. Without the kidneys to filter out things inside your blood, your body quickly becomes full of toxins. Some of these toxins can be life threatening. The quickest way to remove them, temporary dialysis where your blood gets filtered through a machine.

Worst case scenario part two: Compartment Syndrome

Something I didn’t mention in my original post about exertional rhabdomyolysis is how some people can get something called compartment syndrome. Compartment syndrome is usually caused by the affected muscles and swelling to the area. Your skin acts as a compartment, with your muscles, nerves, blood vessels, and bone inside. When swelling gets intense, it can squeeze down on your blood vessels and nerves cutting off blood flow and damaging tissues. The severe end result can be a loss of limb. To address the situation, emergent surgery can be required to slice in to your tissue to relieve pressure.

Worst case scenario part three: Death

If you’re in kidney failure and the issue isn’t addressed, it can be potentially fatal as toxins build up in your blood. Eventually it can lead to death.

Summing up rhabdomyolysis:

Rhabdo is something that doesn’t happen to everyone but when it does, it’s no fun. To prevent it, you are your own best advocate. Proper prevention goes a long way, as does taking care of yourself after vigorous exercise. Next up in the series we’ll be having a case study on the wrong kinds of things to do that will ensure you get rhabdo and also what to do when rhabdo gets you – how to get back to your A-level of fitness.


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Sources:

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3. Hamer, R. “When Exercise Goes Awry: Exertional Rhabdomyolysis.” Southern Medical Journal. May 1997. Web 28 July 2014.
4. Criddle, L. “Rhabdomyolysis: Pathophysiology, Recognition, and Management.” Critical Care Nurse Journal. December 2003. Web. 28 July 2014.
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