Rhabdomyolysis Case Study

Treating a Patient with Rhabdomyolysis
N.T., a 72 year old female with a past medical history of hypertension, COPD hyperlipidemia, and hip surgery was diagnosed with rhabdomyolysis after the patient made a visit to the ER several days following a severe fall. A CMP was ordered which revealed elevated glucose, creatinine, BUN, CO2, and AST values. Also noted were decreased potassium and ALB values as well as severely elevated creatinine kinase levels.
Pathophysiology
Rhabdomyolysis is described as the breakdown of muscle tissue as a result of major muscle trauma. This muscle injury can occur due to excessive overworking of the muscles or from direct trauma. When the sarcolemma is disrupted, a release of intracellular muscle components such as creatinine kinase, muscle enzymes, and myoglobin occurs. Direct trauma combined with various other risk factors including alcoholism, muscle exertion, infections, hyperthermia, diabetes, status asthmaticus, fasting, and certain drugs can result in the development of rhabdomyolysis.
The symptoms of rhabdomyolysis are often subtle and can include muscle pain (especially in the lower back or calves), fever, fatigue, vomiting, nausea, confusion, anuria, and generalized weakness. Dark reddish brown urine is also often noted in people with this condition as a result of

I.V. fluids such as normal saline are utilized to increase volume and aid in the prevention of acute kidney injury. These I.V. fluids are initiated as soon as possible and are continued until the creatinine kinase level drops below 1,000 U/L. Diuretics such as Lasix are sometimes administered to promote the excretion of fluid. Bed rest is typically ordered for patients with rhabdomyolysis. In some cases, if compartment pressure exceeds 25 mm Hg, a fasciotomy and debridement may be