Chapter 89: Rhabdomyolysis

Question 1

The destruction of skeletal muscle caused by any mechanism that results in injury to myocytes and their membranes

Answer 1

Rhabdomyolysis

Question 2

The most common causes of rhabdomyolysis in adults are

Answer 2

Drugs abuse and alcohol

Question 3

Alcohol consumption can result in rhabdomyolysis secondary to ____

Answer 3

Alcohol consumption can result in rhabdomyolysis secondary to coma-induced muscle compression and a direct toxic effect

Question 4

Drug that commonly cause rhabdomyolysis

Answer 4

• Cyclosporine
• Macrolide
• Warfarin
• Digoxin
• Statins

Question 5

The common terminal event in rhabdomyolysis

Answer 5

Na+K+ATPase pump and calcium transport

Question 6

The most sensitive and reliable indicator of muscle injury

Answer 6

Serum creatine kinase

Question 7

How to diagnose rhabdomyolysis?

Answer 7

Most authors consider a fivefold or greater increase above the upper threshold of normal in serum creatine kinase level, in the absence of cardiac or brain injury, as the requirement for the diagnosis of rhabdomyolysis (approximately 800 to 1000 IU/L)

Question 8

When is myoglobinuria develops?

Answer 8

Myoglobinuria develops once skeletal muscle injury is >100 grams

Question 9

True or False
Because myoglobin contains heme, qualitative tests such as the dipstick test can differentiate among hemoglobin, myoglobin, and red blood cells

Answer 9

False
Because myoglobin contains heme, qualitative tests such as the dipstick test do not differentiate among hemoglobin, myoglobin, and red blood cells

Question 10

Imaging modality of choice for evaluating focal muscle damage

Answer 10

MRI

Question 11

Fluid resuscitation for rhabdomyolysis

Answer 11

PNSS 1L/hr then 500ml then regulate to 4ml/kg/hr

Question 12

Urine output goal in patient with rhabdomyolysis

Answer 12

3-4ml/kg/hr or 200-300ml/hr

Question 13

If creatine kinase greater than 10000 IU/L. What fluid is ideal to decrease development of acute renal dysfunction?

Answer 13

Mannitol and bicarbonate in patients with a creatine kinase greater than 10,000 IU/L decreased the development of acute renal dysfunction

Question 14

Hypocalcemia in rhabdomyolysis should be treated?

Answer 14

No. Calcium should be given only to treat hyperkalemia-induced cardiotoxicity or profound signs and symptoms of hypocalcemia

Question 15

Hyperkalemia treatment for rhabdomyolysis

Answer 15

The use of ion-exchange resins (e.g., sodium polystyrene sulfonate) may be effective

Question 16

At what level of phosphate in rhabdomyolysis you start correcting

Answer 16

Serum levels are >7 mil- ligrams/dL (2.25 μmol/L)

Question 17

What scoring use in rhabdomyolysis that predict death or dialysis?

Answer 17

McMahon score