Mon22November1200AM 19

Regarding acute rhabdomyolysis:

True / False

Early haemofiltration is the most important measure in the prevention of acute kidney injury Correct

Creatine kinase levels peak at about four hours after injury Correct

The anion gap is typically raised Correct

Is associated with recreational drug use Correct

Fasciotomy may be required Correct

Explanation

Rhabdomyolysis is caused by the breakdown of skeletal muscle and the release of myoglobin, intracellular and proteins and electrolytes into the systemic circulation. The most common causes are ischaemia secondary to vascular obstruction, crush injury, sepsis and hyperthermia. It is also associated with recreational drug use with cocaine and amphetamines.

The characteristic metabolic derangements include a metabolic acidosis, hyperkalaemia, hyperuricaemia and hyperphosphataemia. There is often a raised anion gap. The marker of muscle damage is creatine kinase (CK) and a plasma level of >5000 IU/L is diagnostic. The levels of CK peak at about 24-72 hours. Myoglobin levels peak before the rise in CK and can be measured in the plasma or urine.

A high index of suspicion is required in patients suffering trauma, crush injury or long periods of immobilisation. The patient may present with compartment syndrome with pain, swelling and reduced movement of a muscle group. The development of acute kidney injury (AKI) is common (65%) and may require renal support. Early and aggressive fluid therapy is key to the prevention of AKI. Where a compartment syndrome exists surgical fasciotomy will be required.

Reference:

Williams J, Thorpe C. Rhabdomyolysis. Contin Educ Anaesth Crit Care Pain. 2014;14:163-166.

Answer Statistics

Not enough data to display the statistics

Average score: 83.90%

Times answered: 277