What is Rhabdomyolysis? Rare condition linked to death of 24-year-old NYC Marathon runner

A 24-year-old woman who died after collapsing just two miles from the finish line of the TCS New York City Marathon had a rare medical condition known as Rhabdomyolysis, her father has said. Steve Apa told The New York Times that his daughter, Rachel, had been sending him text messages earlier in the race, hinting that she was experiencing pain. Her mother was waiting for her at Mile 25, but Rachel never reached that point.

She collapsed at Mile 24. According to race organiser New York Road Runners (NYRR), a bystander initially performed CPR before the organisation's medical personnel took over. A defibrillator was used, NYRR said. Rachel was subsequently transported by ambulance to a Mount Sinai hospital, where she died despite further medical treatment. However, the New York City Office of the Chief Medical Examiner told CBS News that the final cause of death had not yet been determined. NYRR also did not confirm the cause of her death. "We are deeply saddened by Rachel's passing following running in Sunday's race," the organization said in a statement.

What is Rhabdomyolysis?

Rhabdomyolysis is a medical condition in which muscle cells break down and release a protein called myoglobin into the bloodstream, along with potassium and other salts. An excessive amount of myoglobin can damage the kidneys' filtration system. Meanwhile, elevated potassium levels can trigger potentially fatal heart rhythm problems. As many as 50% of people diagnosed with rhabdomyolysis develop kidney injuries. Although the condition is considered rare, approximately 26,000 people in the United States are diagnosed with it annually, according to the Cleveland Clinic.

Rhabdomyolysis and exercise

Rhabdomyolysis can develop following extremely strenuous physical activity. The risk increases when people exercise in hot weather, become dehydrated or continue working out while sick. Athletes can reduce the risk of exercise-related rhabdomyolysis by gradually increasing their physical activity, particularly after taking a break from exercise.

Other preventive measures include drinking sufficient water, avoiding intense workouts during illness and staying away from alcohol and stimulants around periods of strenuous exercise. However, exercise is not the leading cause of rhabdomyolysis. A larger number of cases are associated with drugs and toxins. Alcohol, cocaine and heroin are among the common triggers. In rare instances, statins can also cause the condition, particularly when taken alongside certain other medications.

Other possible causes include infections such as the flu, medical conditions such as heat stroke and seizures, and crush injuries. People with sickle cell trait also face a higher risk of developing rhabdomyolysis.

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What are the symptoms of Rhabdomyolysis?

The most frequently reported symptoms of rhabdomyolysis include muscle pain, muscle weakness and dark-coloured urine that may resemble tea or cola. Some individuals may also experience fever-like symptoms, nausea, confusion or significantly reduced urine output. According to the Cleveland Clinic, symptoms can vary in severity and generally develop within one to three days. Anyone experiencing muscle soreness accompanied by dark urine after an intense workout should seek emergency medical attention as soon as possible.

How is Rhabdomyolysis treated?

The initial diagnosis of rhabdomyolysis involves a blood test to measure creatine kinase, a protein released when muscles are damaged. Once the condition is confirmed, doctors typically administer large quantities of intravenous (IV) fluids containing electrolytes. The treatment helps flush myoglobin through the kidneys. Medical professionals also closely monitor potassium levels to reduce the risk of dangerous heart rhythm complications.

Additional treatment may be necessary if the condition has caused kidney damage. Patients whose kidneys fail or whose potassium levels remain elevated may require dialysis. Physical therapy may also form part of the recovery process. According to the Cleveland Clinic, patients who do not experience complications may begin feeling better within a few weeks. However, doctors may advise them to avoid returning to exercise for several weeks or months.