Weather 
A 24-year-old woman who died after collapsing 2 miles from the finish line of the TCS New York City Marathon had a rare condition called rhabdomyolysis, her father said.
Steve Apa told The New York Times that his daughter Rachel had been texting him indicating that she was in pain earlier in the race. Her mother was waiting at Mile 25, he said, but Rachel never made it to the milestone.
She collapsed at Mile 24. A bystander administered CPR, race organizer New York Road Runners said, until medical staff from the organization took over. A defibrillator was used, NYRR said, and she was transported by ambulance to a Mount Sinai hospital, where she died after further treatment.
The New York City Office of the Chief Medical Examiner told CBS News that no final determination of cause of death has been made. NYRR also did not confirm her cause of death.
“We are deeply saddened by Rachel’s passing following running in Sunday’s race,” the organization said in a statement.
Here’s what to know about rhabdomyolysis and its connection to intense exercise.
What is rhabdomyolysis?
Rhabdomyolysis is a condition that occurs when muscle cells break apart and spill a protein called myoglobin into the blood, along with potassium and other salts.
Too much myoglobin can damage the kidneys’ filtration system, while high potassium can cause a deadly heart rhythm. Up to 50% of people with rhabdomyolysis develop a kidney injury.
The condition is very rare: About 26,000 people in the United States are diagnosed with it each year, according to the Cleveland Clinic.
Rhabdomyolysis and exercise
Rhabdomyolysis can happen after very intense exercise. A person is at higher risk if they’re exercising in hot weather, while dehydrated or while sick.
To prevent exercise-induced rhabdomyolysis, athletes should build up their exercise tolerance slowly, especially after time off. They should also drink enough water, skip hard workouts when sick, and avoid alcohol and stimulants around times of intense exercise.
While rhabdomyolysis can be caused by exercise, more cases are caused by drugs and toxins. Alcohol, cocaine and heroin are all common triggers. In rare cases, statins can cause rhabdomyolysis, especially when they are mixed with certain other medications.
Infections like the flu and conditions including heat stroke and seizures can also cause it. Crush injuries can also result in rhabdomyolysis.
People with sickle cell trait are at higher risk for rhabdomyolysis.
What are the signs of rhabdomyolysis?
The most common signs of rhabdomyolysis are muscle pain, weakness and dark urine that looks like tea or cola. Some people may also feel feverish, sick to their stomach, confused or barely able to urinate.
The symptoms can range in severity, the Cleveland Clinic said. Symptoms usually develop within one to three days.
A person who develops sore muscles and dark urine after a hard workout should go to an emergency room as soon as possible. Physiologist and anesthesiologist Dr. Michael Joyner told CBS News in 2024 that “prompt treatment can really make a huge difference.”
How is rhabdomyolysis treated?
Treatment for rhabdomyolysis starts with a blood test for the muscle protein creatine kinase. Once the diagnosis is confirmed, doctors will give a patient large amounts of IV fluids, including electrolytes, to flush the myoglobin through the kidneys. Potassium levels are also carefully monitored.
Patients may need more treatment if their kidneys were damaged. They may need dialysis if their kidneys fail or if their potassium stays high. Patients may also receive physical therapy.
The Cleveland Clinic says patients without complications may feel better within a few weeks, but doctors may recommend waiting weeks or even months before resuming exercise.
