Rhabdomyolysis

(NEJM 2009;361:62)

• Pathophys: myoglobin-induced oxidant injury, vasoconstriction, myoglobin precipitation & pre-renal (extravasation). Can lead to ↓ Ca, ↑ K, and ↑ PO4.

• Diagnosis: UA ⊕ for heme but 0 RBCs (ie, myoglobinuria)

• Risk of AKI when CK >20,000. Rhabdo and mortality risk score: JAMA Int Med 2013;173:1821.

• Aggressive IVF (tailor IVF to target UOP ~3 mL/kg). If urine pH <6.5, consider NaHCO3 ✓ K & Ca frequently, trend CK. Monitor for compartment syndrome.