Rhabdomyolysis

A 32-year-old man with no significant past medical history presented to the emergency department with complaints of weakness, myalgias, and muscle stiffness. Physical examination was notable for a low-grade fever at 100.8°F, mild tachycardia at 110 bpm, and moderate tenderness on palpation of the muscle groups of the calves, thighs, biceps, triceps, and shoulder girdle. Cardiac auscultation revealed no murmurs, neurologic examination showed no focal deficits, and skin examination was normal. On further questioning, the patient admitted to using crack cocaine for 2 days. Notable laboratory values were as follows: a white blood cell count of 15,000 cells/μL (normal, 4500–11,000 cells/μL), creatine kinase level of 16,500 IU/L (normal, 40–150 IU/L), blood urea
nitrogen level of 29 mg/dL (normal, 8–23 mg/dL), creatinine level of 1.1 mg/dL (normal, 0.6–1.2 mg/dL), and potassium level of 4.0 mEq/L (normal, 40–150 mEq/L). Urine myoglobin was not detected, urinalysis was normal, and urine toxicologic screen was positive for cocaine. Rapid influenza testing was negative. The patient was admitted to the medical floor with a diagnosis of
cocaine-induced rhabdomyolysis.

This review in Hospital Physician covers important questions in management such as when to alkalinize the urine, when to use mannitol and when to dialyze.