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Rhabdomyolysis, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

Abnormal systemic release of muscle contents—creatine phosphokinase (CPK), myoglobin, potassium, phosphate, urate—caused by trauma, poisoning, infection, primary muscle disorders, an...

Diagnosis

Signs and Symptoms

History

  • Can vary dramatically, reflecting underlying disease process.

  • Trauma or crush usually obvious.

  • Consider nonaccidental trauma with unclear details of history.

  • If no trau...

Treatment

Pre-Hospital

  • Rapid extrication in case of crush injury

  • Early IV saline before extrication to prevent complications of restored blood flow to injured limb (hypovolemia, hyperkalemia, etc.)

  • “Crus...

Follow-Up

Disposition

Admission Criteria

All but the most trivial elevations in CPK (<1,000) should be admitted, since complications can occur at any level and are difficult to predict. Children seem...

Treatment

Medication

First Line

  • Bicarbonate; add 50 mEq bicarbonate to each 2nd or 3rd liter to keep urine pH >6.5. Discontinue if urine pH fails to rise after 6 hr or if symptomatic hypocalcemia dev...

Follow-Up

Prognosis

  • No renal failure—almost no mortality

  • Renal failure—3.4–30% mortality

  • ICU—59% if renal failure, 22% without

Complications

  • ARF

  • Hyperkalemia

  • Compartment syndrome

  • Hypocalcemia

  • Acidosis

Pearls and Pitfalls

Suspect in unexplained renal failure. 

Additional Reading

  • Bosch  X, Poch  E, Grau  JM. Rhabdomyolysis and acute kidney injury. N Engl J Med.  2009;361(1):62–72.

  • Huerta-Alardín  AL, Varon  J, Marik  PE. Bench-to-bedside review: Rhabdomy...

Codes

ICD9

  • 728.88 Rhabdomyolysis

  • 958.90 Compartment syndrome, unspecified

ICD10

  • M62.82 Rhabdomyolysis

  • T79.6XXA Traumatic ischemia of muscle, initial encounter

SNOMED

  • 240131006 Rhabdomyolysis (disorder)

  • 111245...

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