Rhabdomyolysis: When Too Much Exercise can be unsafe

What is Rhabdomyolysis?

Rhabdomyolysis is a syndrome where severely overworked or injured muscle cells start to break down and release the byproducts into the bloodstream, which includes a protein called myoglobin. If myoglobin is released in large quantities, the kidneys will not be able to flush it from the blood fast enough and can lead to acute renal failure and even death.

Recently in Singapore, there have been many cases of rhabdomyolysis reported due to over-exercising. In an April 2021 CNA report, a consultant at Tan Tock Seng Hospital (TTSH) said he saw about five overexertion cases in the past month alone.

Contributing factors

Contributing factors to rhabdomyolysis includes :

• Training without proper supervision and guidance (especially for people who are new to the sport)
• Dehydration when exercising in humid and hot temperatures
• Unaware of personal capacity (over exertion)

In most of the scenarios, the participants are stirred up and don't realise they have worked beyond their muscle endurance. This could happen in a spinning studio where the fast tempo music and flashing lights makes ones easy to get carried away, or it could happen in a crossfit gym where your fellow mates are cheering you on, or in a traditional gym where you are trying to rush to reach your new year resolution.

Symptoms

The symptoms to watch out for are

• Persisting muscles pains and cramps that are more severe than expected
• Dark color urine that looks like tea
• Extreme thirst but lower urine output than usual
• Confusion and nausea

However you can’t tell by symptoms alone if you have Rhabdomyolysis. Other conditions like dehydration and heat cramps can cause the same symptoms. The only way to know for sure is to obtain a blood test. Repeated blood tests for the muscle protein creatine kinase (CK or creatine phosphokinase [CPK]) are the only accurate test for Rhabdomyolysis.

Once you suspect that you could be a victim of rhabdomyolysis, you should immediately go to A&E and have it treated as early as possible to prevent any permanent damage to your kidneys. The doctors will likely prescribe you with an agggresive water treatment or IV drip to help your body rehydrate and to flush the toxins from your system.

Things to take note

To protect yourself from overexertion and the nasty side effects, do not rush and push yourself beyond your limits too aggressively, especially if you are just starting out.

As we like to say, health is a marathon and not a sprint, there's no need to hurry. Always keep yourself hydrated during the exercise and try to avoid the outdoors when it's at the hottest and most humid. This is because heat causes muscle to breakdown faster and the kidneys cannot flush out waste if you don’t drink enough fluids.