Marathon rhabdomyolysis: what is known about Rachel Apa’s death

Rachel Apa, 24, died after collapsing near the 24-mile mark of the New York City Marathon, held on Sunday 1 November. Her father attributes her death to rhabdomyolysis, but the cause has not been confirmed and the medical examiner is still investigating.

What is known about the cause

Apa, from Lewisberry, Pennsylvania, was running her first marathon when she died after collapsing at the New York City Marathon.

Her father, Steve Apa, told ABC News on Tuesday 3 November that his daughter had died from rhabdomyolysis. He had previously told The New York Times. NYRR, the race organiser, has not confirmed the cause. The New York medical examiner’s office said that same Tuesday that it was still investigating the death.

In a statement to ABC News, NYRR offered its condolences to her family, friends and the running community: “We are deeply saddened by Rachel’s passing after running Sunday’s race.”

According to her father, Apa had no previous health problems and had trained for the marathon. CNN reports that her medical history, training plan and family history are unclear.

What is rhabdomyolysis?

Rhabdomyolysis is a serious condition that occurs when damaged muscle tissue releases proteins and electrolytes into the bloodstream. According to the US Centers for Disease Control and Prevention (CDC), it can cause nausea, vomiting, organ damage, seizures, cardiac arrhythmias or death.

The kidneys are particularly vulnerable: they may be unable to filter the large amounts of proteins and electrolytes in time, which can lead to acute kidney injury.

The CDC says anyone can develop it, including athletes and marathon runners in excellent shape. Risk factors include heat, trauma and physically demanding work.

Dr Jonathan Kim, director of Sports Cardiology at Emory, who has not treated the case, told CNN that rhabdomyolysis is rare and that deaths from it in marathons would be “very, very rare”.

Symptoms and what to do

General symptoms listed by the CDC include severe muscle pain, cramps, dark-coloured urine, fatigue or weakness, and an inability to complete exercise that was previously manageable. They can resemble those of other heat-related conditions, such as cramps or exhaustion.

Dr Doug Farrell, a nephrologist at Mount Sinai who was not involved in the case, told CNN that early symptoms such as exhaustion, weakness, nausea, vomiting and muscle pain can be mistaken for the normal discomfort of a long race.

Anyone experiencing these symptoms should seek medical attention immediately, according to ABC News. The CDC says mild cases are treated with fluids containing bicarbonate, getting out of the heat and rest, while severe cases may require dialysis, medication or hospital admission.