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Rhabdomyolysis
Hi B and Daniel. My son 21 started going to the gym again last week after few months break. He always like to start the hardest to have gains fast. This time after exercise he was very sore especially legs and he started to see very dark urine despite drinking enough water. He didn’t tell us until two days passed. His urine as per his description was very dark Coca-Cola brown colour with reddish or orange?
He was feeling tired and in pain so we jumped to test him after 4 days passed (because he didn’t say anything first then waiting insurance approval).
Urine test attached and culture test was clear.
Now he went to nephrologist and CK test is requested to make sure kidneys are fine in case it was Rhabdomyolysis.
Two possible scenarios as per nephrologist, either some infection and was clearing out already when tested (we gave him herbal remedies for UTI) or it was mild case of rhabdomyolysis and the body cleared it out.
Please what could be done now if the kidney was affected? Still waiting for the CK test results.
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12 Replies
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We have CK results very high while kidney function normal
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Hey @KK
I’m so sorry to hear. I can imagine you are quite worried!
Elevations in CK can be expected as a result of working out. Strong elevations and dark urine can be an indication of Rhabdomyolysis. Usually, I would expect these symptoms as a result of extreme workouts or prolonged strenuous efforts. Other symptoms that might present are:
Muscle swelling
Weak muscles
Tender and sore muscles
and of course brown, red or tea-colored pee
Rhabdomyolysis
I don’t know what kind of strength training your son did, but it is more usual to see this type of health problem with marathon runners or other sports that require prolonged effort.
With Rhabdomyolysis caused by intensive workouts, your son needs to stay hydrated and replenish electrolytes daily. Also, a journal of symptoms might help. Worsening of symptoms like vomiting, abdominal pain, fever, swollen feet, weak muscles and sore muscles could indicate a progression of the condition. If symptoms become progressive, contact your nephrologist immediately! The good news is that your nephrologist thinks of a mild version of Rhabdomyolysis indicating your son isn’t in immediate danger. But I do recommend that he check his symptoms.
Although workouts can cause Rhabdomyolysis and perhaps the most likely, it isn’t the only cause of Rhabdomyolysis. Depending on the cause, different approaches should be taken,
Kidney function
At the moment of drawing blood, the lab values that evaluate kidney function look pretty good. This means that if there is some kidney damage, the damage isn’t enough to impair kidney function. That’s good news! That doesn’t mean there isn’t any kidney damage, but it does mean that the damage didn’t result in function loss. This was at the time of measurement (4 days after the first symptoms presented). It could be that your nephrologist might want to retest these lab values, just to be sure his kidney function is still ok.Pus cells
Although his white blood cell differential doesn’t immediately give an indication of an infection, pus cells were found in the urine. Pus cells in the urine mean that there were some white blood cells present in the urine. Sometimes the urine will smell like ammonia. This would fit more with a UTI. Although UTIs are the most common cause of pus cells in the urine, some other infections can cause pus cells as well. Your nephrologist will know how to deal with that.In the case of an infection, staying hydrated is really important as well. If your son is sexually active, you could recommend him to pee directly after sex to clear bacteria from the urinary tract. I’m not sure what herbal remedies you’ve used, but following the tips in this handout can be helpful as well.
Once it is clear what caused the dark urine, we might be able to give you more targeted advice.
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@Daniel Schepers Hi Daniel, thank you for thorough response.
He has been admitted to hospital just to hydrate him via IV.Workout was definitely the cause, he started going again to the gym and lifting weigh but he does it to the extreme as usual but maybe he was not hydrated enough this time.
Urine colour was the main indicator but he was feeling a bit tired and sore muscles.
His second urine test came back clear and not even pus or anything else. No protein which is also good..
They’ll retest him now but the dr said everything should be fine since no problem with kidney function and he’ll make sure everything is ok with kidney.
I was wondering now when he can go back to the gym and if it’s safe to take creatine.
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@Daniel Schepers hi Daniel. I just need some advices please. So son as I mentioned above was admitted to hospital and all tests were done and thank God his kidneys are safe and itching to worry. Dr suggested it was an incident after dehydration and workout.
All normal and tests normal.Any tips? Especially he wants to go back to the gym.
Also @Bernadette Abraham do you think the chronic nausea has RO do anything with this? You remember? My son was first live case you took for chronic nausea and we still don’t know the cause. He’s managing better but still there. Could dehydration or anything else to look for?
Thank you guys -
@KK glad to hear all is clear with his kidneys. I vaguely recall the details of your son’s case but I do remember that we discussed several possible causes and solutions to try to help rule things out.
Can you please update us with what else you’ve tried since then; what’s worked, what hasn’t worked.
Majority of the time, chronic nausea has to do with histamine intolerance and/or liver dysfunction.
Did you ever try the DAO enzyme before bed to see if that helped his morning nausea?
Since you’re in Dubai, I’d also like to recommend seeing Dr. Hu at Shanghai Medical Clinic for a consultation. He’s a senior Chinese herbalist and acupuncturist. He assesses the body by looking at the tongue and pulse on the wrists. His treatments usually involve a concoction of customized Chinese herbs and acupuncture. He’s excellent and worth a visit.
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Hey @KK,
When it comes to workout tips for your son, the most important tips are quite simple: make sure he hydrates well and make sure he replenishes his electrolytes. Listening to his body is also important. If he feels fastly fatigued or sore and tired during his workout he should definitely take it slow. Taking pre-workouts might dehydrate him as well and I wouldn’t recommend them.
If he likes intense workouts and you’re afraid his health might suffer again. You could explain to him that continuously giving it all in the gym might even lead to lesser results. I’m not opposed to heavy workouts, but I do tell my clients that if they start working out after a long break, they risk starting heavier as needed. This is because when you return to your workout routine, you already have the experience of how working out should feel.
However, the body isn’t adapted to this lifestyle anymore.
Another downside is that if he is focussed on building strength and muscles he is going to make progress in the future more difficult.
The body adapts to the way you’re training. If the start is aggressive and the body adapts to this, you need a different training stimulus that ‘shocks’ the muscles into developing more strength and muscle growth. If you’re giving it all you’ve got from day 1, it becomes much harder to shock muscles in the future.
A more easy start will have the benefit that there is more room to shock the muscles and he might see better muscle growth and strength development during the year.
As he progresses in his training, the body will also be better able to handle the stress of intense workouts because the body will try to adapt to his new lifestyle.
He could also pay attention to how he feels after a workout. Once you are done with the strength training workout, you should feel tired, but not exhausted. This might be different if he competes in sports, but if his main goal is to build strength and grow muscles, this is perfect.
Extreme workouts will cause longer recovery times. Being “under recovered” is why a lot of people who work hard in the gym don’t progress in the gym.
I hope these tips will help him to give the results he wants while staying healthy at the same time!
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@Bernadette Abraham the only thing we were able to find was low elastase. He took. Creon for short period then the results came back normal. It’s pancreatic insufficiency if I’m right. I tried to find any tips in this regard where not couldn’t.
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@Daniel Schepers very helpful as usual Daniel, thank you
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@KK did his nausea improve while taking Creon? Did the doctors rule out possible contributing factors of pancreatic insufficiency such as type 1 or 2 diabetes, celiac disease, obstructions in the pancreas, autoimmune pancreatitis, etc?
From a functional perspective, hypochlorhydria can lead to poor signaling and weak pancreatic enzyme release. Have you tried the baking soda challenge test to see if low stomach acid is a possibility? HERE’S a video on how to do that (skip to 3-minute mark).
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@Bernadette Abraham all ruled out. Will try the baking soda challenge thank you
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@KK please report back
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