An 18-year-old female student from Suzhou joined the fitness and weight-loss craze. After a strenuous 45-minute cycling workout the previous night, she went on an outing the next day. When she returned home that evening, her lower limbs were sore, and her urine turned "soy sauce-colored." She was immediately taken to the hospital by her family and later diagnosed with rhabdomyolysis syndrome, almost costing her life.
Exercise and outing, urine turns soy sauce-colored
Chen Qiang, director and chief physician of the Nephrology Department at the North District of Suzhou Municipal Hospital, told the Yangzi Evening News that the 18-year-old female patient was a student majoring in art at a vocational college in Suzhou. She weighed only about 90 jin (approx. 45 kg) and was actually quite "slim and pretty." A while ago, seeing many female classmates dieting, she asked her parents for money to get a gym membership.
According to the patient’s recollection after seeking medical help, she had cycled for 45 minutes at the gym before the incident. She sweated profusely but did not feel any discomfort at the time.
The next day, the girl noticed soreness and swelling in her lower limbs but did not take it seriously. She still went on an outing with her classmates in the suburbs of Suzhou. In the evening, she suddenly found her urine had turned soy sauce-colored. She was then rushed to the hospital by her parents for emergency treatment.
Nearly caused kidney failure
Chen Qiang told the Yangzi Evening News that test results showed the girl’s creatine kinase level was 279 times the upper limit of normal, while liver function tests indicated significantly elevated transaminase levels. "Clinically, it is considered that the patient developed rhabdomyolysis syndrome due to intense exercise," he said.
Subsequently, the hospital admitted the patient to the ICU for treatment. They administered large amounts of saline solution and also gave sodium bicarbonate to alkalinize her urine. At the same time, they immediately started continuous blood purification therapy to reduce the creatine kinase level in her blood. "At that time, the patient’s condition was still deteriorating, with creatine kinase levels progressively rising, peaking at 107,660 U/L, which is 673 times the normal value," Chen said.
It is understood that the normal range for human creatine kinase is typically around 196 U/L. Elevated creatine kinase, simply put, means an increase in myoglobin in body fluids, which can eventually block the renal tubules, prevent normal urination, and lead to kidney necrosis or kidney failure.
Fortunately, due to timely medical attention, the girl’s various indicators gradually returned to normal.
Excessive exercise causes the body to "break down"
Chen Qiang told the Yangzi Evening News that in his more than 20 years of medical practice, this was the first time he encountered such a dangerous case related to exercise.
Chen analyzed that the main reason the girl developed severe rhabdomyolysis syndrome was likely because she had never engaged in high-intensity or strenuous exercise before, causing her body to be unable to respond in time—resulting in a "breakdown." Of course, individual differences might also have played a role. "Not everyone is suited to this kind of fitness and weight loss method. When choosing fitness or weight loss activities, one must proceed step by step and act within one’s limits," he said.
Chen stated that the key to treating rhabdomyolysis syndrome lies in early detection, diagnosis, and treatment. First is to remove the cause and stop further muscle damage. This is followed by fluid hydration, urine alkalinization, maintaining water-electrolyte balance, and promptly addressing complications. Additionally, since myoglobin is a medium-molecular-weight substance, continuous blood dialysis treatment should begin as early as possible to reduce or avoid damage to the renal tubules and prevent acute kidney failure. The reason the girl achieved good therapeutic results in the end was fundamentally due to the immediate administration of large-scale hydration therapy, urine alkalinization, and timely continuous blood dialysis in the emergency room (at the earliest possible moment).
■ Term Explanation
Rhabdomyolysis Syndrome
Usually occurs after severe muscle injury, such as after a major earthquake where many patients develop rhabdomyolysis syndrome from being crushed under rubble, leading to acute kidney failure. Other causes include excessive exercise, high-voltage electric shock, alcohol abuse, or consumption of "shrimp-washing powder," taking excessive sleeping pills leading to prolonged fixed sleep postures that cause localized muscle compression, certain lipid-lowering medications, etc. There are also some rare cases, such as multiple bee stings or venomous snake bites, that can trigger it.
Sohu Health Supplementary Reading: Unscientific Exercise Can Cause Rhabdomyolysis
Unscientific exercise training can lead to energy depletion in the body, increased production of free radicals, enhanced tissue permeability, thereby causing the release of inflammatory factors and resulting in muscle tissue damage. Some patients may even develop complications such as acute kidney failure and multiple organ dysfunction syndrome. Currently, the focus is on treating the underlying cause, reducing muscle damage, restoring blood flow, and preventing acute kidney failure due to unscientific exercise.
Myoglobin in muscles can form crystals in the renal tubules, blocking them and affecting kidney function. When myoglobin flows into the kidneys, it is also toxic to the kidneys. Mild cases may result in hemoglobinuria, while severe cases can lead to kidney failure. Rhabdomyolysis syndrome mostly occurs in young people in their 20s. Excessive exercise disrupts the body’s own harmony and can be even more harmful than not exercising at all. To avoid over-exercising, one should progress gradually and act within one’s limits during workouts. Fitness enthusiasts should diversify their exercise routines to avoid fatigue caused by repetitive activities.
Exercise-induced rhabdomyolysis is a group of skeletal muscle injuries caused by excessive physical activity. Clinical manifestations include muscle pain, swelling, weakness, and brown urine. The main features are elevated serum creatine kinase, myoglobin, and the presence of myoglobinuria, often accompanied by acute kidney failure. Early treatment of the underlying cause, restoration of blood flow, and prevention of acute kidney failure are of significant clinical importance for improving prognosis.