From the Guidelines
No, you typically wouldn't start seeing symptoms of rhabdomyolysis weeks after a triathlon, as rhabdomyolysis symptoms usually appear within hours to days after extreme physical exertion. The classic symptoms of rhabdomyolysis include:
- Muscle pain, weakness, and swelling
- Dark, cola-colored urine
- Decreased urine output
- Fatigue
- Nausea and vomiting If severe kidney problems were to develop from rhabdomyolysis, they would typically manifest within a few days, not weeks later. Sudden kidney failure two weeks after a triathlon is unlikely to be directly caused by the event itself, as supported by the American Heart Association and American College of Cardiology 1.
The evidence suggests that exertional sickling scenario could promote rhabdomyolysis and disseminated intravascular coagulation, which in turn could lead to hyperkalemia, lactic acidosis, worsening hypoxia, impaired cardiac and renal function, and lethal arrhythmias 1. However, this process happens over hours to days, not weeks.
It is essential to note that athletes with sickle cell trait (SCT) are at a higher risk of developing rhabdomyolysis and other complications, and specific precautionary recommendations have been advanced for targeted and tailored measures during training to enhance the prevention of sudden death 2.
If someone experiences sudden symptoms like muscle weakness, dark urine, or decreased urination after intense exercise, they should seek immediate medical attention. Early treatment, which often involves aggressive IV fluid administration, is crucial for preventing complications. The reason symptoms appear quickly is that muscle breakdown products are released into the bloodstream rapidly after injury, overwhelming the kidneys' ability to filter them out, as discussed in the context of heat-related illnesses and exertional heat stroke 3.
In summary, rhabdomyolysis symptoms are unlikely to appear weeks after a triathlon, and any delayed symptoms should be evaluated for other potential causes.
From the Research
Rhabdomyolysis Symptoms and Renal Function
- Rhabdomyolysis is a clinical syndrome defined by muscle breakdown and subsequent release of intracellular contents, which can lead to impaired renal function due to hyperkalemia 4, 5, 6, 7.
- The symptoms of rhabdomyolysis can include muscle pain, weakness, and dark urine, associated with elevated creatine kinase (CK) levels 4, 6.
- Exertional rhabdomyolysis is occasionally seen after strenuous exercise, and the progression to compartmental syndrome or renal failure is a rare complication that requires prompt recognition and treatment to prevent morbidity 4, 5.
Timing of Rhabdomyolysis Symptoms
- While the studies do not specifically address the timing of rhabdomyolysis symptoms after a triathlon, they do suggest that the condition can occur after strenuous exercise 4, 5.
- It is possible that rhabdomyolysis symptoms could appear weeks after a triathlon, although this is not explicitly stated in the studies.
Renal Function and Hyperkalemia
- Rhabdomyolysis-induced renal failure is caused by the precipitation of myoglobin in the renal tubules, which is enhanced under acidic conditions 7.
- Hyperkalemia is a potential complication of rhabdomyolysis, and can contribute to impaired renal function 4, 7.
- Early, aggressive resuscitation with fluids is the most important intervention in preventing the development of acute renal failure 7.