Rhabdomyolysis: Evidence-Based Management in the Emergency Department

Points and Perls Excerpt

• There is no consensus on the single most commoncause of rhabdomyolysis in adults, but studies havefound that drugs, alcohol, coma, toxins, and arterialocclusions are among the common causes.The leading cause of rhabdomyolysis in childrenaged ≤ 9 years is viral myositis.
• The signs and symptoms that are typically reportedin rhabdomyolysis include muscle pain, weakness,and dark urine, though all 3 are rarely seen together.Fever is a common complaint in the pediatric popu-lation; a study found that it was present in 68% ofchildren with rhabdomyolysis.
• The gold standard for the diagnosis of rhabdomyolysis is an elevated creatine kinase (CK) level.
• There is no strict CK level cutoff that defines rhabdomyolysis; however, 5 times the upper limit ofnormal, or 1000 U/L, is a commonly cited cutoff.

Most Important References

• Veenstra J, Smit WM, Krediet RT, et al. Relationship between elevated creatine phosphokinase and the clinical spectrum of rhabdomyolysis. Nephrol Dial Transplant. 1994;9(6):637-641. (Retrospective chart review; 93 patients) DOI: 10.1093/ndt/9.6.637
• Brown CV, Rhee P, Chan L, et al. Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference? J Trauma. 2004;56(6):1191-1196. (Retrospective chart review; 2083 patients) DOI: 10.1097/01.ta.0000130761.78627.10
• de Meijer AR, Fikkers BG, de Keijzer MH, et al. Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey. Intensive Care Med. 2003;29(7):1121-1125. (Retrospective chart review; 26 patients) DOI: 10.1007/s00134-003-1800-5
• Chen CY, Lin YR, Zhao LL, et al. Clinical spectrum of rhabdomyolysis presented to pediatric emergency department. BMC Pediatr. 2013;13:134. (Retrospective chart review; 37 patients) DOI: 10.1186/1471-2431-13-134
• Mikkelsen TS, Toft P. Prognostic value, kinetics and effect of CVVHDF on serum of the myoglobin and creatine kinase in critically ill patients with rhabdomyolysis. Acta Anaesthesiol Scand. 2005;49(6):859-864. (Prospective and retrospective cohort study; 47 patients) DOI: 10.1111/j.1399-6576.2005.00577.x
• Cho YS, Lim H, Kim SH. Comparison of lactated Ringer’s solution and 0.9% saline in the treatment of rhabdomyolysis induced by doxylamine intoxication. Emerg Med J. 2007;24(4):276-280. (Randomized controlled trial; 28 patients) DOI: 10.1136/emj.2006.043265
• Holt S, Moore K. Pathogenesis of renal failure in rhabdomyolysis: the role of myoglobin. Exp Nephrol. 2000;8(2):72-76. (Review) DOI: 10.1001/jama.288.20.2547
• Manis T, George-Varghese B, Kashani J. Rhabdomyolysis - go big or go home. Am J Emerg Med. 2019;37(12):2194-2196. (Retrospective chart review; 115 patients) DOI: 10.1016/j.ajem.2019.03.024