Internal Medicine Solution 14
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Rhabdomyolysis causes hyperkalemia.
Signs and Symptoms of rhabdomyolysis:
Local effects- muscle pain, tenderness, swelling, bruising, weakness
Systemic effects- Tea-colored urine (from increased myoglobin), anuria/oliguria, fever, malaise, nausea, vomiting, confusion, agitation, delirium
Diagnosis:
Urine dipstick- useful for screening; orthotoludine part turns blue in presence of hemoglobin or myoglobin
Urine or serum test for myoglobin
CK elevated 5x normal
Increased AST, ALT, LDH
Increased BUN and Cr due to renal failure
Decreased calcium, increased K, urate, WBC, and high anion gap acidosis
Complications:
Early: hyperkalemia due to massive muscle breakdown which can lead to cardiac arrhythmias and arrest
Hepatic inflammation (25%) due to proteases released from muscle
Hypocalcemia due to Ca binding with PO4 released from muscle
Late: acute renal failure (15-30%) occurs within 12-24hrs
DIC due to muscle injury causing activation of clotting cascade and release of tissue thromboplastin and renal microthrombus formation, occurs days 3-5
Early/Late: Compartment syndrome due to muscle expansion limited by tight fascia
Category: Medicine MCQs
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