So I had a terrible half on Saturday in 100+ heat index. I had a nutritional failure on the bike. I got handed a water bottle instead of Heed. My stomach did not like the water. I lost all my nutrition on the asphalt at mile 30. I was treating the whole day as a training day for IMFL, so I was not going hard at all. Anyway, I decided to really take it easy on the run and made it to mile 7.2 before cramps started. Aid stations were not prepared for the excessive heat and were poorly supplied. I finished but should have quit.
After the race I knew I something was not right. I went to ER and got 2 bags of fluid. The ER Doc flipped out on my CPK value (above 1000 is all they could say), Troponin value and Creatinine value (3.19). I talked him into retesting them after the second bag of fluid. The Troponin and Creatinine dropped to almost normal but the CPK was still over 1000. He made me promise to see my PCP on Tuesday. I did and got new lab work done. Now my PCP is wanting to discuss my CPK level (3706). FYI, on Tuesday my Creatinine was 0.90 and my Troponin is below 0.31.
My question is how long should it take for CPK to recover after a long endurance event when you get dehydrated? We do not have any internal sports meds in my area, only orthos. My PCP probably hasn’t seen anything like this before either. Am I having an issue or is this normal for our sports?
I am still going to see my PCP and will probably see a specialists at his direction.
You had a pretty classic case of rhabdo- you got dehydrated and your muscle started breaking down. The break down of your muscle overwhelmed your kidney function that was all ready impaired from your dehydration. People can go into permanent kidney failure with rhabdo. And that was why the ERdoc was freaking out. The good thing was that you had gotten rehydrated and your creatinine is back to normal. I’m not sure when your CPK will be back to normal but it has all ready peaked. The main concern (your elevated creatinine in the setting of a rising CPK) has all ready passed.
It should be fine in the next 3-4 days. Just as long as your urine doesnt turn dark brownish in color. Keep hydrating. Most labs don’t fractionate the ck unless you ask them. 3-4k is not really that big of a deal from a health risk perspective. As previously noted as long as your creatinine is good, you’ll be fine.
I would not necessarily expect the levels to return to normal for a week. As others have stated, rhabdo causes kidney impairment (and can cause kidney failure requiring dialysis). Keep hydrating, and have your PCP repeat the levels in a day or 2 to ensure they are declining. after that can wait a week fo the next draw.
Damn way to Htfu but it’s probably the wrong choice.
U got lucky your kidney recovered.
It still took a hit and is probably worse off ( even by a little bit ) than previous.
Ck can take days or even weeks to normalize.
Depends if you are still working out or not.
What about the troponin? They didn’t say anything about that?
You’re probably more likely to get Rhabdo again in the future given similar circumstances so be careful.
Awesome responses STers! Thanks. Ya. The Docs were flipping out about the Troponin too. They had me on a heart monitor, did 2 EKGs and a chest x-ray. I have NOT gotten my heart rate above 90 since Saturday. I almost went for a ride today until I got the call from my PCP. I am really stressing about not getting to train with IMFL only 10 weeks out. Oh well. I was not shooting for a podium spot by any stretch of the imagination. I will make sure to stick strictly to my nutrition plan, no water on the bike. Period. The Rhabdo is what my PCP is probably worried about. I am sure he thinks my ticker is being eaten alive. I read an article linked in an old thread on ST that talked about voluntary post CPK tests after the Western States ultra 100 mile run. It noted many athletes with CPK between 15,000-30,000 and were not showing any signs of distress.
Again, Thanks for all the awesome answers. Any other ideas? Please chime in.
Mild elevations in troponin can be see from rhabodo as well especially in the setting of ARF. I’m not sure I agree with psoas about your kidneys taking any sort of significant long-term hit although possible, creatinine levels appear elevated by the CPK alone, and do not necessarily reflect the true extent of renal function at the time of measure. I would be curious to know exactly how high your troponin level was at the time and what exactly your cpk level was at the time. I am not sure if I would still expect your cpk to still be elevated 3-4 days later if you renal function returned to normal, if they remain elevated, persistently even at a mild level it could indicate a different underlying problem that you only discovered because of the episode you had at the half. Were you taking any “statin” medication (for cholesterol) or any NSAID (ibuprofen type meds) on race day? As previously stated, the large danger is renal failure from much higher levels than 3k. depending on your age, risk factors, family history, and risk tolerance I would consider refering you to a cardiologist depending on the troponin level elevation seen during your episode of rhabdo, but this would almost be more of a CYA measure. There is certainly no urgency in working up a mild elevation in your cpk though so I probably would order anything more than a recheck level for the cpk at this point. I am not a nephrologist or cardiolgist…
Age 36
No Statins
I do take 800mg of ibuprofen daily for arthritis in my lower back (injury from years ago) but actually did NOT take any the day of the race.
My Troponin at the time of admission in ER was 0.44 and after 3 hours 40 minutes was 0.19.
My creatinine was 3.1 upon admission and 1.9 at 3h and 40min.
After the first bag of IV fluid I was able to urinate. It was dark yellow at first but ended clear. I gave two samples and nothing abnormal in either. All future urinations were light yellow to clear.
The first EKG was abnormal. The second was normal. Paternal familial history of cardiac disease. Maternal familial history of diabetes caused renal failures.
I just had a complete physical 2 months earlier and EVERYTHING was very, very good. I even had my lead levels checked due to high lead in the area I live.
I will say that at mile 12 of the run/walk I could feel slight discomfort in my kidney “area” and also a discomfort in my left abdomen area below my ribs. I was NEVER short of breathe. I was driving and just could not focus, almost like I was drunk. I thought my glucose was low but initial test was 133. Sodium was 131.
As far as initial CPK? All the hospital I stopped at (closest to my position) could tell me was greater than 1000.
Stay away from the NSAIDS for the next week or so (until CPK levels return) as they can effect renal function. Stay hydrated (urine clear) and as your kidneys are back to normal for the most part you will flush the CPK fairly quickly (3-4 days vs. the 1 week that some have mentioned) You really weren’t too elevated (I’ve seen greater than 15k) on the whole, so you should be fine. Also, the troponin levels weren’t too elevated-the fluid and renal stress you went through can effect that as well.
If you are on any blood pressure meds that end in -pril or -sartan I would stop them immediately and temporarily as well. PM me if you have other med questions-I’m a pharmacist, not an MD, but have seen quite a few rhabdo cases at work in my hospital.
Trirunner, I am NO prescription meds at all. I take ibuprofen 800mg a day, Loratidine for allergies, fish oil and multi vitamin. That’s it. I seriously appreciate the advice!
And Jodi, my labs improved dramatically before the ER doc released me. Before that second set of labs he was absolutely not going to let me go.
Do u have your urinalysis results?
With that low of ck, I would’ve thought u were just pre renal, but myoglobinuria I think would favor Rhabdo.
Either way fluids fluids.
I’d be curious to see what your ck is in a week and after IM Florida.
You are now more prone to get it again though, so don’t be a champ or a chump (I.e. underlying genetic predispo).
And as for elevated ck elevating troponin? I don’t buy that at all.
It’s a cardiac specific protein. U had damage to your heart. Period.
Albeit small, but it was still present.
International Journal of Cardiology
Volume 96, Issue 1, July 2004, Pages 35-40
doi:10.1016/j.ijcard.2003.04.053 | How to Cite or Link Using DOI
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Doesn’t mean I wouldn’t work it up. Given an Abnormal “EKG” I probably would, but 0.41 is a very mild elevation and could easily be attributed to renal failure/rhabdo.
it is pretty well known that endurance athletes get minor damage to the heart during endurance events - it is some of the theory behind sudden death of gentically predisposed individuals (think Jim Fixx). Given the fast resolution of labs I would not be concerned with the troponin and would be watching renal function.
as to the pharmacist who states cpk clear in 3-4 days well that depends - my experience (primary care and sports medicine) shows otherwise and I would not be concerned if it takes a week.
I am SHOCKED that you were not instructed to avoid nsaids until resolved. Also no alcohol, watch the caffeine intake and HYDRATE - keep your urine clear.
it is pretty well known that endurance athletes get minor damage to the heart during endurance events - it is some of the theory behind sudden death of gentically predisposed individuals (think Jim Fixx). Given the fast resolution of labs I would not be concerned with the troponin and would be watching renal function.
as to the pharmacist who states cpk clear in 3-4 days well that depends - my experience (primary care and sports medicine) shows otherwise and I would not be concerned if it takes a week.
I am SHOCKED that you were not instructed to avoid nsaids until resolved. Also no alcohol, watch the caffeine intake and HYDRATE - keep your urine clear.
What is funny is that I asked specifically about ibuprofen and the ER Doc said it would not be a problem. The ER nurse later disagreed when removing my IV. I did not take any ibuprofen until yesterday (5 days with none). I will deal with a stiff lower back for a couple of weeks until this is all squared away. I have had no alcohol. My caffeine intake has been moderate (20 oz coffee in AM, one 44 oz tea all day) rest is water and gatorade. Urine is light yellow to clear. Any ideas I can give my PCP about normal full recovery for the renal function? I am 99% certain he will have no experience with the endurance athlete aspect of all this.
doi:10.1016/j.ijcard.2003.04.053 | How to Cite or Link Using DOI