Contributed by Kim Zuber, PA-C, who oversees patients in
 seven dialysis centers for Metropolitan Nephrology Associates, Clinton, Md.


A 35-year-old woman presented to us in the emergency department complaining of “black urine.” She had decided to lose weight, so she joined a spinning class. The average age of others in the class was 65 years.

As she explained to us, “I thought I could keep up with all those old ladies.” Alas, she could not. She rode her heart out, yet the rest of the class left her behind. At the end of class, she was a bit shaky and sweaty, so she drank a bottle of a well-known sports drink.

As she walked out to her car, her back hurt and her legs started cramping. She took a couple of ibuprofen tablets and drank a bottle of water. Later that evening, since she was still sore, she popped two more ibuprofen tablets and drank a second bottle of sports drink. In the morning, her urine was black, and she immediately went to the emergency room.

Her creatine phosphokinase levels were >2,000 IU/L (10 to 120 IU/L), and she was admitted with presumptive rhabdomyolysis. Her acute kidney injury reversed over the next 48 hours with conservative care: IV fluids, sodium bicarbonate, and dextrose. However, she has learned her lesson — never try to keep up with an “old lady!” (200-5)


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