Contributor: Ricky Dhaliwal, MD

Educational Pearls:

• Rhabdomyolysis occurs when high levels of myoglobin are released from dying muscle tissue into the blood
• Severe levels of myoglobin cause renal injury
• Causes include elevated temperature, excessive exercise, toxins, infection, muscle ischemia, crush injury, and prolonged immobilization
• Can also be caused by medications, like antipsychotics, statins, SSRIs, colchicine, lithium
• Workup typically includes creatinine kinase, potassium, creatinine levels and serial EKGs
• Firstline treatment is with IV fluids with a goal urine output of 300 ml/hr
• Sodium bicarbonate and mannitol have had some use in treatment but weak evidence

References

Long B, Koyfman A, Gottlieb M. An evidence-based narrative review of the emergency department evaluation and management of rhabdomyolysis. Am J Emerg Med. 2019 Mar;37(3):518-523. doi: 10.1016/j.ajem.2018.12.061. Epub 2019 Jan 2. PMID: 30630682.

Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

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