Rhabdomyolysis

Question 1

A 42 year old male recommenced weight training after a hiatus of 10 years. He presents 48 hours after his first session, which included 2 hours of heavy weight lifting, complaining of severe pain and tenderness in his back, shoulders and biceps muscles. He describes “blood” in his urine for the last 24 hours and his urinalysis shows +++blood and +++protein. His serum creatinine is 169 mcrmol/L (<120). How would you investigate and manage him?

Answer 1

Impression
Clearly man is presenting in a state of rhabdomyolysis with a concomitant AKI. +++ blood likely represent myoglobinuria and +++ protein due t

DDx
- consider polymyositis/dermatomyocitis
- Drugs/toxins
Other causes of AKI given raised creatinine.
- Pre-renal
- Renal
- Post-renal

Question 2

Hx

Answer 2

History

• sx: muscle pain, fatigue, temporal relationship to symptoms. Triad for Rhabdo: generalised weakness, dark urine, muscle pain/myalgia.
• AKI: drugs, other meds, compartment syndrome (pain disproportionate to injury and passive movement)
• rest of medical Hx

Question 3

Ex

Answer 3

Examiantion

• General appearance + vitals
• MSK examination
• systems review

Question 4

Ix

Answer 4

Investigations

• Bedside: UA for confirmation, urine MCS
• Bloods: serial CK to ensure its trending down, serial ECG for complications associated with rhabdo including hyperkalaemia; UEC, LFT, CRP
• Imaging: nil