[##]-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 significant evidence of hyperkalemia on labs [with an unremarkable EKG]. Patient noted to have no other evidence of significant electrolyte abnormalities on labs [look for hypophosphatemia, hypocalcemia, and hyperuricemia]. Patient noted ton have no evidence of associated AKI.
Patient treated with normal saline IV [with 1-2 liter bolus] given in ED in patient noted to be tolerating fluids by mouth prior to discharge. Patient felt to be appropriate for outpatient management given likely exertional rhabdomyolysis and absence of associated comorbidities [including heat stress, dehydration, crush injury, trauma], electrolyte abnormalities, or renal failure [consider admission in patient with CK >30,000]. Prior to discharge we discussed the importance of increased intake of fluids, rest and avoidance of further exertion, and follow up with [primary care provider/here in this ED] for repeat CK to ensure this is downtrending within [24/48/72 hours]. We also discussed return precautions, specifically for evidence of renal failure, and the patient demonstrated understanding and agreement with this plan.
http://www.emdocs.net/emdocs-cases-evidence-based-recommendations-for-rhabdomyolysis/
Patient treated with normal saline IV [with 1-2 liter bolus] given in ED in patient noted to be tolerating fluids by mouth prior to discharge. Patient felt to be appropriate for outpatient management given likely exertional rhabdomyolysis and absence of associated comorbidities [including heat stress, dehydration, crush injury, trauma], electrolyte abnormalities, or renal failure [consider admission in patient with CK >30,000]. Prior to discharge we discussed the importance of increased intake of fluids, rest and avoidance of further exertion, and follow up with [primary care provider/here in this ED] for repeat CK to ensure this is downtrending within [24/48/72 hours]. We also discussed return precautions, specifically for evidence of renal failure, and the patient demonstrated understanding and agreement with this plan.
http://www.emdocs.net/emdocs-cases-evidence-based-recommendations-for-rhabdomyolysis/
No comments:
Post a Comment