The Sierra Club's Annual One Day Hike
–  Since 1974  –

Washington, DC to Harper's Ferry, WV
–  50K • 100K  –

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Trail First Aid – Rhabdomyolysis

Source: The Comprehensive Guide to Wilderness First Aid, by Clifton Castleman, WEMT.

On average, each year the ODH tends to see one or two hikers suffer from Rhabdomyolysis. Rhabdomyolysis (Rhabdo for short) is a serious condition that results from the breakdown of muscle fibers which lead to the release of myoglobin into the bloodstream.

When muscle is damaged (such as by exertion), a protein called myoglobin, one of the building block protiens of muscle, is released into the bloodstream and then filtered out of the body by the kidneys. Myoglobin breaks down into substances that can quickly overwhelm and easily damage kidney cells, a potentially life-threatening condition if not recognized or treated in time.

Triggers: Exertion & Not Enough Electrolytes

Rhabdomyolysis may be triggered by several things that we see at the One Day Hike: excessive exertion, hyponatremia, Hiking 30 miles; let alone 60 miles in one day is exceptionally strenuous - even for those who have trained for it.

For that reason, the element of exessive exertion may be inevitable for both 50K and 100K hikers. Hyponatremia is a condition where the body has too much fluid and not enough salt. Many people overhydrate at the One Day Hike, but the key is to continuously eat salty foods and snacks along the way - especially at the support stations.

In the initial stages of Rhabdo, if a person is also hyponatremic, electrolyte levels are often abnormal and require correction. High potassium levels can be life-threatening, and respond by attempting to increase urine production.

Signs & Symptoms

The signs and symptoms of rhabdomyolysis may look a lot like those of shock or an acute stress reaction (ASR); however, coupled with the circumstances of completing the One Day Hike, the first aid volunteers at the end point, Bolivar Community Center, will be atuned to checking all patients for the following signs and symptoms:

  • Abnormal urine color (dark, red, or cola colored)
  • Decreased urine production
  • General weakness
  • Muscle pain & tenderness
  • Weakness & swelling of the affected muscles
  • Low blood pressure
  • Shock -
    • Nausea & vomiting
    • Rapid, shallow heart rate
    • Rapid, shallow breathing
    • Confusion or disorientation
    • Cold & shivering

Treatment & Prevention

Temporary treatment of Rhabdomyolosis in the field may include the administration of calcium to protect against cardiac complications, and the administration of a calcium bicarbonate solution dissolved in orange juice.

Throughout the One Day Hike, drink plenty of fluids to dilute your urine and flush any myoglobin that is released from your muscles out of your kidneys – but don't forget to also eat salty foods as well. Overhydrating may result in hyponatremia. Also be sure to drink plenty of fluids after the Hike for the next several days.

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