“A case of Rhabdomyolysis…” Case Conclusion March 6, 2012
Posted by Andy Jagoda, MD in: Uncategorized , trackback
The Conclusion Is…
The patient had clearly developed pneumonia, which was unsuccessfully treated from the previous hospitalization, and nowhttp://www.ebmedicine.net/empblog/wp-admin/post.php?post=40&action=edit&message=1 presented with severe sepsis. You treated her with broad-spectrum antibiotics, taking into account her risk for gram-negative bacteria, and started crystalloid infusion to support her hemodynamically. You found that the she had developed rhabdomyolysis from sepsis and had already developed acute renal failure, with a BUN:Cr ratio concerning for myoglobinuria-induced renal failure. You checked the urine pH, which was 4.6, and switched her normal saline to 0.45% saline with 2 ampules sodium bicarbonate per liter to alkalinize the urine to a pH > 6.5. You continued early goal-directed therapy, performed endotracheal intubation to decrease her work of breathing, and consulted your intensive care unit for admission.
Congratulations to Dr. Hugo, Dr. Anda, Dr. Achacoso, Dr. Cohen, and Dr. Peschanski— this week’s winners of Emergency Medicine Practice’s “Rhabdomyolysis: Advances In Diagnosis And Treatment!” For an evidence-based review of the etiology, differential diagnosis, and diagnostic studies for Rhabdomyolysis, read this issue.