[##]-year-old [male/female] with [back pain/dark/bloody urine/etc.] with history and exam consistent with rhabdomyolysis.
Initial consideration in this patient included rhabdomyolysis, acute kidney injury (AKI), hematuria from causes including kidney or ureteral stone, urinary tract infection (UTI), pyelonephritis, or malignancy, glomerulonephritis, musculoskeletal etiologies of back pain, cauda equina syndrome, intervertebral disc herniation, and change in urine color from foods such as beets, blackberries, rhubarb, food coloring, or fava beans among others.
Patient presented with report of [back pain/change in urine color] concerning for rhabdomyolysis. We obtained a urinalysis that was notable for being [grossly/moderately] positive for blood with [no/minimal] red blood cells noted on microscopic analysis. Patient reports [describe recent exertion] within [12-72 hours/1-2 days] of presentation. Labs were obtained to include a creatinine kinase (CK), which was noted to be [moderately/significantly] elevated. Patient noted to have [no] evidence of hyperkalemia [specify]. A 12-lead EKG was obtained [and noted to be unremarkable/and notable for evidence of peaked T waves suggestive of hyperkalemia]. Patient noted to have [no] evidence of AKI [based on increase in creatinine from baseline/with an AKIN score/RIFLE classification of RIFLE-R/I/F/FO].
Patient treated with normal saline IV [with 1-2 liter bolus followed by an infusion at 2.5 mL/kg/hour] while monitoring urine output. Patient felt to require admission based on [comorbdities/associated trauma/heat injury/associated kidney injury/consider admission in patient with CK >30,000]. Case discussed with Dr. [Name of Internal Medicine/the admitting hospitalist] who evaluated the patient in the ED and agreed with need for admission. We discussed planned admission and treatment plan with the patient who demonstrated understanding and agreement with this plan.
http://www.emdocs.net/emdocs-cases-evidence-based-recommendations-for-rhabdomyolysis/
https://www.mdcalc.com/akin-classification-acute-kidney-injury-aki
https://www.mdcalc.com/rifle-criteria-acute-kidney-injury-aki#evidence
Patient treated with normal saline IV [with 1-2 liter bolus followed by an infusion at 2.5 mL/kg/hour] while monitoring urine output. Patient felt to require admission based on [comorbdities/associated trauma/heat injury/associated kidney injury/consider admission in patient with CK >30,000]. Case discussed with Dr. [Name of Internal Medicine/the admitting hospitalist] who evaluated the patient in the ED and agreed with need for admission. We discussed planned admission and treatment plan with the patient who demonstrated understanding and agreement with this plan.
http://www.emdocs.net/emdocs-cases-evidence-based-recommendations-for-rhabdomyolysis/
https://www.mdcalc.com/akin-classification-acute-kidney-injury-aki
https://www.mdcalc.com/rifle-criteria-acute-kidney-injury-aki#evidence
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