Rhabdomyolysis

This picture demonstrates “coca-cola” colored urine, which often occurs in rhabdomyolisis. Rhabdo occurs when there is injury to skeletal muscle cells leading to release of cellular contents. Causes of rhabdo include: muscle trauma, drugs of abuse, excessive muscle use, genetic disorders, dermato/polymyositis, infection, compartment syndrome, and medications.

Rhabdo is diagnosed by obtaining a CK level. The most concerning complication of rhabdo is renal failure. Myoglobin precipitates and obstructs the renal tubules where ferrihemate (product of myoglobin breakdown) is directly toxic.

Treatment consists of aggressive IV fluids. The goal is to obtain a urine output of 2ml/kg/hr, if the patient makes urine. Otherwise, dialysis may be required. A good choice for fluids is 3 amps of NaBicarb in 1L of D5W at a rate of 200-300 ml/hr (adjust rate to an appropriate urine output). The goal is to raise the urine pH greater than 6.5 to prevent myoglobin from precipitating in the kidneys.