Background: Serious complications after running a marathon are relatively rare. We saw a patient at the emergency department (A&E) who developed acute renal failure as a result of rhabdomyolysis after excessive exertion.
Case description: A 31-year-old, healthy male was referred to the A&E by the GP service two days after running a marathon because of a CK level of 131,900 U/l. At the A&E, he was experiencing severe muscle pain, was continuously vomiting and experiencing reduced diuresis. Lab tests revealed a serum creatinine level of 705 µmol/l, indicating acute renal failure. In order to improve renal perfusion, the patient was treated with aggressive fluid administration and was monitored. After a hospital stay of 17 days, the patient was discharged in good condition.
Conclusion: Acute renal failure caused by rhabdomyolysis after exertion is caused by a combination of adverse environmental factors, risk factors and genetic predisposition. We recommend referring runners who have a body temperature of > 40°C and are experiencing changed awareness after a marathon to the hospital for assessment.