Date:
Patient:
Reason for Visit:
Admission/Evaluation for rhabdomyolysis
Assessment of muscle damage severity and organ dysfunction
Management plan discussion
History:
Presenting Illness:
Onset and duration of symptoms (muscle pain, weakness, dark urine)
Potential causes of muscle injury (e.g., trauma, crush injury, strenuous exercise, medications, statins, illicit drugs)
Past medical history (relevant conditions like infections, electrolyte imbalances)
Physical Exam:
General: Assess for signs of dehydration, swelling, and tenderness in affected muscle groups.
Neurologic: Evaluate for muscle weakness.
Urine: Inspect for color (dark, tea-colored) suggestive of myoglobinuria.
Diagnostic Tests:
Laboratory Tests:
Serum electrolytes: Evaluate for imbalances (potassium, phosphorus) released from damaged muscle cells.
Creatine kinase (CK): Levels are markedly elevated in rhabdomyolysis.
Urinalysis: Presence of blood (hematuria) and myoglobinuria.
Renal function tests: Assess for kidney injury (elevated creatinine, blood urea nitrogen).
Other tests (may be indicated): Liver function tests, coagulation studies, toxicology screen.
Imaging Studies (may be ordered depending on suspected cause):
X-ray: Evaluate for fractures or bone injuries.
MRI scan (muscle damage): May be used to assess extent of muscle injury (not routinely used).
Assessment:
Severity of muscle damage: Based on clinical presentation, CK levels, and myoglobinuria.
Risk of complications: Electrolyte imbalances, acute kidney injury (AKI), compartment syndrome (increased pressure within muscle compartment).
Potential underlying cause: Identify the cause of muscle injury to guide treatment.
Plan:
Aggressive intravenous fluid resuscitation: To prevent kidney injury and promote myoglobin clearance.
Electrolyte correction: Address imbalances (potassium, phosphorus) to prevent cardiac arrhythmias.
Alkalinization of urine: May help prevent further kidney damage by increasing myoglobin solubility.
Pain management: Medications to improve comfort and reduce muscle inflammation.
Monitoring: Close monitoring of urine output, electrolytes, kidney function, and CK levels.
Consultations: Consider consultation with nephrology if AKI develops or urology for compartment syndrome concerns.
Addressing the underlying cause: Specific treatment based on the identified cause (e.g., stopping offending medications, treating infections).
Patient education:
Explain the diagnosis of rhabdomyolysis and the importance of treatment adherence.
Discuss potential complications and the importance of reporting any worsening symptoms.
If relevant, educate the patient about avoiding triggers that may have caused rhabdomyolysis.
Follow-up:
Frequent monitoring until CK levels trend down and clinical improvement occurs.
Repeat laboratory tests to assess response to treatment and kidney function.
Depending on severity, hospitalization may be required for several days.
Outpatient follow-up with a physician to monitor recovery and address any long-term complications.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of rhabdomyolysis.