Rhabdomyolysis - Go big or go home.
Am J Emerg Med. 2019 Mar 14;:
Authors: Manis T, George-Varghese B, Kashani J
OBJECTIVE: To evaluate the occurrence of renal injury in hospitalized patients with the diagnosis of rhabdomyolysis among a series of patients presenting to an urban emergency department.
METHODS: A retrospective chart review between January 2006 and February 2017 was conducted on patients aged 21-65 years old that were admitted with a diagnosis of Rhabdomyolysis. We included patients with an initial serum creatinine (Cr) level < 1.3 mg/dL and an initial serum creatine phosphokinase (CPK) level > 1000 U/L. We excluded patients with preexisting renal disease, hypertension, diabetes, patients currently on medications in the statin class, patients with muscular dystrophy and neuromuscular disorders.
RESULTS: One hundred and fifteen patients (100 men, 15 women) were enrolled, with a mean age of 36 years old. The mean CPK at presentation was 18,965 U/L and the highest CPK was 168,300 U/L. The mean Cr upon presentation was 0.95 mg/dL. The average length of stay of our patients was 4.6 days. The longest length of stay was 30 days and the shortest was 1 day. Seven patients had hospital stays longer than 10 days. None of the patients had prolonged admissions due to rhabdomyolysis alone. The patient admitted for 30 days had a protracted admission due to liver failure and sepsis thought to be unrelated to Rhabdomyolysis. No patients that fit our inclusion criteria developed renal insufficiency (Cr > 1.3 mg/dL) or failure regardless of their CPK upon presentation, peak CPK or therapies received during their hospitalization.
CONCLUSION: Patients in our data set that presented to the Emergency Department with a CPK of >1000 U/L and a Cr of <1.3 mg/dL that were hospitalized with a diagnosis of rhabdomyolysis are not at risk for developing renal insufficiency or failure if treated promptly with fluid rehydration, regardless of their initial CPK values.
PMID: 30902360 [PubMed - as supplied by publisher]