Does your urine look like COCA COLA? - GO STRAIGHT TO HOSPITAL - RhabdomyolysissteemCreated with Sketch.

in life •  2 years ago

Introduction

If you ever hear of relatively fit and healthy young people dropping dead during strenuous activity you normally think of heart related causes like cardiomyopathy or a straightforward myocardial infarction (heart attack).  

There is a another potential cause which I would like to discuss and is not as rare as people might think.   It is called Rhabdomyolysis and it affects about 26000 people a year annually in the US.

I will first cover my own personal experience followed by a brief overview of what this disorder is.

N.B. This is intended for regular non-medical people to read and is not a guide for clinicians.  

If you are a heath professional I would reccomend this article on Medscape (note login/registration maybe required) for a more clinically focussed approach.


My Experience


Idiot at the Gym

In 2012 I decided to go back to the Gym to work on my shrinking musculature.  (Note the photos is not me!)

Being a textbook idiot I decide to lift weights with my ego rather than using my actual muscles or utilising my brain at all.  

It had been a good few years since I had gotten out of the habit of going to the gym, but despite this I was trying (very badly) to lift the same kind of weights and do the same kind of intensity I used to.  

Bad idea.

When I got home I felt pretty sore - but not the worst I had ever felt after a workout.  I also didn't seem to have an injury like a muscle tear or anything that would restrict my movement.

(The photo below is not me either sadly.)


My urine looks like Coca Cola

I went to pass urine and there was an unpleasant suprise. 

It came out a very dark brown colour with a red tinge.  This was not like concentrated urine when you are dehydrated.  (Note the photo is not a serving suggestion for your urine.)

This was not just dark but like pure undiluted Coca-Cola or Dr Pepper and this was despite being well hydrated and having drunk more than 500ml of water about half an hour earlier.

I felt no pain or other symptoms on passing water as I would if I had a UTI (urinary tract infection).  There was also no smell that I was able to detect.

Had I not known about these things I might have ignored it because I felt fine.  I'm sure a lot of people do.  Some of those people probably end up dead or seriously injured as a result of ignoring this and other signs.

I knew what it was immediately.  Rhabdomyolysis (scroll down for explanation) - exercise induced in this case. 


Fun at the Hospital

So I took myself straight to hospital and explained the situation.  

Unfortunately I had some blank stares when explaining the situation as many people, even health professionals, don't really think about this very often.  

Some of the first nurses I saw were telling me "You should have been drinking plenty of water to prevent this".  

Whilst it is important to stay hydrated to protect your kidneys this is not the cause of rhabdomyolysis and I explained I had been drinking plenty of water.  I think some of them thought I just had very concentrated urine due to dehydration.  

So I found myself explaining what was actually going on to quite a few people who hadn't actually come across it before or had forgotten about it.

Thankfully I ended up under the care of the very nephrologist who taught me as a student.  It would have looked bad if I hadn't spotted this! 

I was on a drip in hospital being monitored for the next 3-4 days and being given plenty of fluids.  It was incredibly boring but I was very lucky to not have had any complications.  

Had I not known about this serious condition and ignored it I could well be dead now or with very serious damage to my kidneys.


What is Rhabdomyolysis?

Rhabdo - referring to striped (striated), myo to muscle, lysis means destruction of cells.  (Image shows muscle cells.)

- It is a disorder where the breakdown of excessive quantities of striated (skeletal) muscle cells releases potentially toxic breakdown products into the bloodstream.  

These can cause damage to the renal (kidney) tubules resulting in acute renal failure which is very serious and a potential cause of sudden death often due to potassium abnormalities.

  

Early treatment can prevent any damage to the kidneys occuring, hence preventing renal failure and further complications.

As I said in the introduction when you hear of people suddenly dropping dead after or even during a marathon or athletic event - this can be a common contributing cause.  

- If you slip into acute renal failure it can disrupt levels of blood electrolytes particularly potassium which can lead to fatal abnormalities of heart rhythm.  

Even if it does not reach that point there can be long lasting damage to your kindeys causing chronic renal failure.


What causes it?

Basically anything that can damage muscle cells (a comprehensive list would be too long to post here) but some common causes are:

  • extreme muscle strain or injury e.g. marathons, athletic events, being an idiot at the gym
  • drugs e.g. alcohol, cocaine or certain medications (e.g.statins) which can cause damage to muscle cells
  • crush injuries or immobilisation which exerts continuous pressure on large muscles

Rarer:

  • electric shocks/burns
  • hyperthermia (raised body temperature) or heat stroke
  • metabolic disorders like ketocidosis
  • muscular diseases e.g. muscular dystrophy
  • viral or bacterial infections
  • cancers either directly or indirectly due to metasteses

Signs/Symptoms

Mainly muscular pain or weakness but can be asymptomatic.  The classic clinical triad for presentation (source Medscape) is:

  • myalgias (muscle pain)
  • generalised weakness
  • dark urine

However this is only seen in about 50% of patients.

In more severe cases or latter stages can cause abdominal pain, nausea, raised pulse, reduced urine output and fever.  Alteration of consciousness can also occur.


What to do - VERY IMPORTANT

-Go to hospital ER/Casualty immediately and inform them of your symptoms.  

Even if you are wrong it is not worth waiting around to see.  

(Also maintain your hydration by drinking water - don't force it down though, that can cause problems in itself.)


Diagnosis/Tests (basic there are many more see link)

  • History and examination (injury, muscle soreness, pre-existing condition etc), including visualisation of urine.
  • Urinalysis for myoglobin (an oxgen carrying protein similar to haemoglobin that is found in muscle cells, it has a red/brown colour and gives the urine it's characteristic appearance).
  • Blood tests for muscle enzymes such as CK (Creatine Kinase).
  • Routine bloods can help to elucidate the cause and U&Es (Urea and Electrolytes) are used to monitor renal function.
  • It is also standard practise to keep an eye on liver function too, liver enzyme disruption may occur which can confuse the issue.
  • Specific tests to narrow down causes depending on the situation and clinical history.

Treatment

This mainly involves flushing the kidneys with IV fluids and monitoring for signs of renal failure. 

In severe cases dialysis may be required and any metabolic or secondary complications as a result of renal failure will need to be treated.  

If it is a secondary complication of a pre-existing disease or illness then that will need to be appropriately managed or brought under control too.

Most people who get to hospital in time suffer no long term consequences.


TLDR- If your urine looks like Coca-Cola go straight to hospital - even if you feel fine - your life could depend on it.


Conclusions

I have kept this as simple as possible for people to read.  I hope I have struck the right balance.

If you want more detailed information I would recommend reading the Wikipedia article which actually contains a lot of useful information.  For detailed clinical information I would reccomend the Medscape update.

This post has not been sponsored by Coca-Cola or Dr Pepper!


The Obligatory Kitten Photo

Thank you for reading.  I hope you found it useful.

If you like my work and aren't already, please follow me and check out my blog (I mainly discuss photography but I do other topics too) -  @thecryptofiend 


I have also created a new channel in the chat dedicated to photography of people/portraits called "Photography-portraits-people".  Please check it out and post your photos there.


Image Credits:  All images are taken from my Thinkstock account.


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Some of my Previous Posts and Tutorials:

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I had rhabdo about eight years ago. Luckily it was a relatively mild case and caused no long-term damage, but there were many worrisome months of elevated CK levels, low GFR and random episodes of edema. I remember when I presented myself at the emergency department in the middle of the night and told them I thought I had rhabdomyolysis, everyone thought I was nuts. But alas, I'm glad that I knew about it and recognized the symptoms.

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Yes I think a lot of people don't know what you are talking about when you mention it - particularly if they are not medically trained staff! They assume you are just a hypochondriac who hasn't had enough water.

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Totally!

Great post indicative of a very serious problem.

I'm so pleased that you had the foresight to go and check it out in time to be treated and recover fully. Raising aware of such issues can only be a good thing and I commend you for that.

Fantastic article as is always delivered by you, @thecryptofiend.

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Thank you so much for your support:)

@thecryptofiend, when I was in coast guard basic training, this condition was actually common. Remember my urine being really foggy dark yellow but never to that dark orange brown that they warned us about. Such a thing of of over stressing the body.

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Not surprising if you are extending yourself a lot. There is also something called march haematuria which can discolour urine in people who are walking or marching a lot like soldiers. It is caused by excessive degradation of red blood cells as a result of mechanical stress.

Great post @thecryptofiend I am happy to see that you are ok now.
And yeah it was the right decision to go straight to the doctor...I am not a doctor ...but I can say that all should know that the color of our urine should be ...well ...no color...somethimes can be yellowish and this is still normal but that is because the are some elements that we pass there, for example potasium...and again this is normal....BUT any other color other then that means that is something wrong and the person needs to visit a doctor.
Well done @thecryptofiend!

Interesting and useful information thank you. Anther reason not to overdo exercise ;)

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Glad you find it useful:)

I'm a hypochondriac so this just adds to my list. In a weird way, I am saying thank you.

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Best to get them all crossed of lol:)

Rhabdomyolysis is no joke, and anyone who loves to work out should be well versed in the symptoms.

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Yes for sure. I never imagined it could happen to me and the weird thing was how well I felt aside from a little muscle soreness which was not extreme for me after a workout. The clinical triad of signs/symptoms isn't present in a lot of cases and generally if we feel OK then we assume nothing is wrong.

The problem is by the time you start to feel ill it might be too late and you may already be in acute renal failure. Once that happens your Potassium levels can get abnormal very fast and that can destabilise your heart rhythm leading to sudden death. That's a bit of an extreme case but it does happen.

That's why some people just suddenly drop dead as a result of it after extreme exercise challenges.

Interesting.

I was really happy to see a puppy included in the kitty photo. That got my upvote. :P

Wow. Crazy that you can feel fine, yet be in serious danger. Glad you came out ok!

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Well sometimes people do feel pretty bad - just not always. Thank you for your support:)

@thecryptofiend I only drink water and always on the move plus hydrated but I read and have no regrets - better be informed cause who knows - one day when I turn 40 which is 2 years from now - I might become one of those

idiot at the gym

giggles :)

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Yes it can happen to anyone at any age depending on the cause.

So ; I do apologize , but I simply MUST ask . . . If your urine looked like Coke Cola what part of the etiology or physiological process creates the little gas bubbles in your urine ?
: )

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Lol. I should make it clear that it is the colour that looks like Coca Cola. If it is carbonated too then something very strange is going on!
If you had a bowel fistula too connecting to your bladder/urinary tract then I suppose you could end up with bubbles but actual fizzy urine is not likely:)

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I am an RN and just could not work it out, but in truth that was my pitiful attempt at homour to ask about the gas bubbles. My lady's dad is the dark side of 85 and the red in his urine is bladder Ca > radiation Rx.

Personally i have written herein b4 about young people and low carb high diets, I think if you have any spare money to invest you will make a lot of money in the future from buying / renting renal dialysis machines. Young people had better start learning fundamental health principles before they start reaching middle age or they are very likely going to spend a lot of time around health professionals waiting rooms . . .

I am sure a Rep 65 like yourself is very busy, but maybe you might enjoy this link to a crazy work out athlete ?

https://steemit.com/health/@crok/exercise-the-frank-medrano-way-exercise-way-once-you-qualify-from-my-300-second-exercise-program-you-must-see-this

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I know lol. But it was a good point about clarity:)

Personally i have written herein b4 about young people and low carb high diets, I think if you have any spare money to invest you will make a lot of money in the future from buying / renting renal dialysis machines. Young people had better start learning fundamental health principles before they start reaching middle age or they are very likely going to spend a lot of time around health professionals waiting rooms . . .

Yes extreme diets and anything that encourages ketosis +/- rapid muscle breakdown can increase the risk. Luckily we have the NHS here so we don't have people profiteering from health care like in some other places. I imagine dialysis would be lucrative especially given the explosion of diabetes too.

No problem will check your post out.

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I am a Registered Nurse in Australia and registered in the United States so I know some of the differences : )

I tried for England or Britain or Britex or whatever " over the pond " is called now-a-days, but a person over the age of thirty cannot work in Britain.

Rules and job protections . . .

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They might have relaxed it now.

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(nested 6 deep reply)
I would love to see the History, the 500 year old pubs etc.

Last I found was if you are not 'connected' and over 30 years old you cannot get a work visa . . .

But who knows anything anymore in the crazy New Age Y2K Modern World : )

To be candid, this kind of infection affected my mother in early 2107, that was the first time i saw it. I was scared, but all glory to the almighty, she recieved her last treatment in the late august and we are grateful to God. i fukced up not writing a post on this, but when i see yours it reminds me of the tragic moment. Unfortunately, i wouldhave resteem, but the icon is no more here again. Thanks for sharing this, as it is a great advantage to humanity.