Rhabdomyolysis

Question 1

Rhabdomyolysis

Answer 1

Characterized by skeletal muscle injury and release of intracellular contents into the systemic circulation - namely potassium, phosphate, myoglobin, creatinine kinase, and lactate dehydrogenase

Question 2

What can rhabdo cause

Answer 2

Can cause intrarenal AKI seconary to myoglobin obstruction of the renal tubules due to muscle breakdown

Question 3

Diagnosis of Rhabdomyolysis

Answer 3

• History - crush injury, fall followed by prolonged immobility, concomitant drug use, status epilepticus
• physical exam
• elevated serum Creatine Kinase > 1000 (generally continues to rise x12-24h post-injury before beginning to decline. Serial CK measurements Q12h is useful as a prognostic indicator for AKI
• urinalysis +ve for blood (but microscopy NOT), suggesting myoglobin as cause for urinalysis result not hemoglobin

Question 4

What patients get Rhabdomyolysis (5)

Answer 4

Anything that causes muscle breakdown:
- Cancer
- Active that do not hydrate properly
- Fall patients (elderly) - down for long periods of time. if you see an area of necrosis
- Uncontrolled seizure activity for a sustained period of time
- Pts that are shivering for long periods (hypothermic)

Question 5

Clinical Manifestations (6)

Answer 5

• aching muscles
• Tea-coloured urine
• reduced urine output
• tachycardia secondary to pain, dehydration, or fluid shifts
• muscle swelling can be present on admission or become apparent after the patient has recieved fluid resuscitation
• Bruising/pressure sores - compression injury

Question 6

Collaborative Care (5)

Answer 6

• aggressive IV isotonic fluid resuscitation with crystalloid to reduce renal vasoconstriction and produce dilute urine, thereby reducing myoglobin precipitation.
• accurate recording of intake + output
• monitoring pt for signs of fluid overload
• RRT as needed to treat AKI
• Trending CK and renal function tests (BUN, Creatinine, eGFR), along with electrolyte panel