Before writing this chapter I though I understood rhabdomyolysis fairly well. I had treated many cases, read about it in a few books, and heard a lecture or two on it. However, writing this chapter has forced me to realize that I didn't really understand rhabdo well at all. This disease is generally poorly understood, with almost no high-quality evidence available. Most of the conventional teaching on rhabdomyolysis is based on assumptions and dogma. This chapter attempts to make sense of the topic, but many questions remain.
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The IBCC chapter is located here.
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Within the (laconic) emergency medicine community we would not be worried until the CK is 4 figures, maybe 5.
Sorry can’t count, I meant “until CK is 5 figures, maybe 6”. That is, interested at 10000, concerned at 100000,
The data is all over the place on CK. I’ve tried to present a reasonable interpretation of the literature and general consensus, but in reality this is very far from being clear. It’s possible that we over-diagonose and over-treat rhabdomyolysis.
Same here, in patient with normal renal function, I don’t care about CK level <10 000, but I admit I may be wrong.
2 questions, :
– why don't we check myoglobin serum level (routinely available in my shop) instead of CK to make the diagnosis and assess the need for fluid therapy ?
– anyone using mannitol if patient is adequatly fluid resuscitated and urine output still low?
Honestly I don’t think the data is strong enough to say if anyone is “right” or “wrong” on this. I think the chapter presents a reasonable take on the literature which seems fairly consistent with most published articles on this – but there are a *lot* of unknowns here. I am fully expecting to have to revise this chapter within the next few years based on new guidelines and/or newer evidence. 1) checking myoglobin is an interesting idea. I suppose you would need to measure the level right when the muscle damage was occurring. This isn’t available to me (and… Read more »
Excellently written, very educative, but please allow me a comment for the sake of correctness. There is nothing like creatinine kinase. Instead it should read creatine kinase. Creatinine is generated spontaneously (without involvement of any enzyme) by dephosphorylation of phosphocreatine,
How suspicious should you be if the K+ is low and never increases that the hypokalemia is causative of the rhabdo? How frequently does hypoK contribute?
Wonderfully summarised.
I think scoring for age in McMahon score is written wrong here.
I’m not a doctor. I’m a mother of two children who have gotten rhabdomyolysis from viral infections at different times but similar ages presenting in similar symptoms. I have been reading as much as I can about this condition and have a question. If ck is produced from the muscles being damaged, is there a ratio to muslce mass and ck elevations. Say my 4 year old has small muscle mass, would a higher level not be an indicator of a bigger problem due to her size? If I do a body scan, and my muscle mass is 130lbs I… Read more »