Rhabdomyolysis - Differential Diagnosis and Management Summary Trauma: • Immobilization, Crush iniury, Compartment syndrome, Electrical injury Exertional: • Hyperthermia/Heat exhaustion, Heat iniury, Heat stroke, Metabolic myopathies, Excess exertion/training, Seizures, Malignant hyperthermia, Neuroleptic malignant syndrome Nontraumatic nonexertional: • Electrolytes, Toxins. Drugs (Statins), ETOH Infection (Viral- HIV, Influenza, TSS, Herpes, Coxsackie etc), Endocrine (Hypo/Hyperthyroidism), Autoimme (polymyositis/Dermatomyositis) AKI - Pathophysiology: 1. Shift of extracellular fluid into injured muscles -> HYPOTENSION -> renal vasocontriction-> decreased renal renal ischemia 2. Cast formation: Renal tubular obstruction 3. Direct myoglobin nephrotoxicity 4. Heme associated free radicals- oxidative iniury Treatment: 1. Prevent Prerenal azotemia: Isotonic saline 2. Iinitial rate: 1-2 L/hour with goal urine output: 200ml/hr 3. Monitor potassium and calcium several times per day until stable 4. Loop diuretics for fluid overload 5. Dialysis for severe hyperkalemia or ATN 6. Allopurinol for hyperuricemia if levels > 8mg/dL See updated Rhabdomyolysis Schema here: https://www.grepmed.com/images/1072 #Rhabdomyolysis #Differential #Diagnosis #Management #Summary #causes #treatment
