I have recently had two emergency room visits with the exact same symptoms 2- 3 weeks apart from each other. The first time was june 18th after a 15k tough Mudder in which I had performed very well. I am 205lbs at 5’9.5’ with 8% BF by DEXA. The race was in the morning and I had not had much to eat prior to the event and also have chronically poor sleep averaging ~ 5 hours night for longer than a week. I get prescribed adderall and took my medication as normal which was 15mg quick release about 1 hour prior to the race which took me 2 hours. I was previously an army ranger and have been training consistently for over 11 years so the event honestly seemed at most @RPE8. By the end my stomach felt completely empty with slight Discomfort around my low abdomen and low back. To me, this felt as it would after pushing myself on a long endurance event (possible soreness from use / butterfly feeling I sometimes get from long endurance exercises, not sure if I have to use the bathroom or not, etc). I was on week 4 of the endurance program prior to the race and honestly do not feel like I exerted myself that much. I have had a cyclic vomiting disorder for awhile and after the race was getting the feeling of some nausea (stomach turning/ cramping) and diarrhea, which I thought could be from having an empty stomach and possibly increased mass movement in my intensities. I started to get really gassy and burping or vomiting would relieve my stomach pain after the pain would increase (was going from 4 to 7 and back around consistently after the race). I did not have much desire to eat or drink because of this which alarmed me because I knew I was hungry and thirsty but felt as if the normal signals were not there.
Eventually the pain got worse and was not going away so I took myself to the ER. I was given haloperidol and Zofran for my stomach pain along with an IV. My CPK levels were around 4,000 and they gave me a diagnosis of rhabdomyolysis. My urine was not an abnormal color and did not think I had traditional symptoms of Rhabdo. I thought my symptoms were more on the IBS side. Eventually it lowered to an acceptable level and then released me.
Fast forward to July 1st, approximately 1 hour after the first 5 min interval sprint workout which I was also quite fasted for I had a smoothie and instantly started feeling the same symptoms I had a few weeks prior. This time it was much worse, I could only walk hunched over and had severe cramping. I began to sweat profusely which lasted over 15mins until I was treated at the ER. I was seen much faster and given IV fluids right away along with zofran (oral) to calm my stomach pain. This time my CPK levels were only ~700. I was given a diagnosis of “nausea and vomiting” and released with instructions to intake more fluids.
I personally do not think my CPK was high enough for rhabdo and the 2nd instance with lower CPK makes me think it was something else. My sprint workout was only ~30 mins and overall RPE8
My primary care doctor is now concerned about my kidney function. I have previously had slightly elevated creatinine ~1.4? Which after listening to countless podcasts I imagine is attributable to my above average muscle mass
Does CPK normally increase after strenuous exercise and by how much? Does my ER visit sound like rhabdo or do you guys think its potentially something else? I have had prior substance abuse issues and had recently been taking Kratom in powder form which I also informed my doctors about at the ER. I think it may be a gastrointestinal problem and potentially related to substance abuse.
Curious and appreciative of what you guys think,
Andrew