145. Flush Away the Crush - An Approach to Rhabdomyolysis

Rhabdomyolysis involves the breakdown of striated muscle, a process driven by ATP depletion and the subsequent failure of transmembrane pumps to regulate intracellular calcium. This cellular collapse releases creatine kinase, myoglobin, and electrolytes into the bloodstream, potentially triggering acute kidney injury, life-threatening hyperkalemia, and compartment syndrome. Diagnosis relies on identifying elevated creatine kinase levels—typically five times the upper limit of normal—and recognizing clinical signs like dark, "coca-cola" colored urine. Management prioritizes aggressive volume resuscitation with isotonic crystalloids to maintain a urine output of 200 mL per hour, alongside the correction of electrolyte imbalances. Identifying the underlying trigger, whether trauma, immobilization, or medications like statins, remains essential for preventing recurrence. Prognostic tools like the McMahon calculator further assist clinicians in predicting the risk of mortality or the need for renal replacement therapy based on initial laboratory and demographic data.