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ALL / Nephrology
Rhabdomyolysis
Rhabdomyolysis
Rhabdomyolysis will typically feature in the exam as a patient who has had a fall or prolonged epileptic seizure and is found to have an acute kidney injury on admission.Causes
- seizure
- collapse/coma (e.g. elderly patient collapses at home, found 8 hours later)
- ecstasy
- crush injury
- McArdle's syndrome
- drugs: statins (especially if co-prescribed with clarithromycin)
Features
- acute kidney injury with disproportionately raised creatinine
- elevated creatine kinase (CK)
- the CK is significantly elevated, at least 5 times the upper limit of normal
- elevations of CK that are 'only' 2-4 times that of normal are not supportive of a diagnosis and suggest another underlying pathophysiology
- myoglobinuria: dark or reddish-brown colour
- hypocalcaemia (myoglobin binds calcium)
- elevated phosphate (released from myocytes)
- hyperkalaemia (may develop before renal failure)
- metabolic acidosis
Management
- IV fluids to maintain good urine output
- urinary alkalinization is sometimes used
+PassMedicine Notes
Rhabdomyolysis will typically feature in the exam as a patient who has had a fall or prolonged epileptic seizure and is found to have an acute kidney injury on admission.
Causes- seizure
- collapse/coma (e.g. elderly patient collapses at home, found 8 hours later)
- ecstasy
- crush injury
- McArdle's syndrome
- drugs: statins (especially if co-prescribed with clarithromycin)
- acute kidney injury with disproportionately raised creatinine
- elevated creatine kinase (CK)
- the CK is significantly elevated, at least 5 times the upper limit of normal
- elevations of CK that are 'only' 2-4 times that of normal are not supportive of a diagnosis and suggest another underlying pathophysiology
- myoglobinuria: dark or reddish-brown colour
- hypocalcaemia (myoglobin binds calcium)
- elevated phosphate (released from myocytes)
- hyperkalaemia (may develop before renal failure)
- metabolic acidosis
- IV fluids to maintain good urine output
- urinary alkalinization is sometimes used
