14. Other Organ Involvement
●Liver injury – Liver dysfunction, typically
reversible, occurs in up to 25 percent.
●Neurologic – Altered mental status due to
toxins, drugs, trauma
●Pulmonary – Respiratory failure or ARDS
15. History And Examination
●Recent trauma
●Prescription medications with attention to
myotoxic agents
●Alcohol and/or substance abuse
●Prolonged immobilization
●Strenuous or unaccustomed physical exertion or
exercise
●Heat exposure or hyperthermia of any cause
●History of myopathy or muscular dystrophy
●Prior episodes of rhabdomyolysis
●Electrocution/ Burn injury
●Convulsive seizure
18. Initial laboratory studies
●CBC P.Smear for infection or hemolysis
● Urinalysis
●RFT
●Routine electrolytes plus calcium and
phosphate, for hyperkalemia, hypocalcemia,
and hyperphosphatemia
●Liver function tests
19. ● PT, aPTT ,D-dimer, and fibrinogen, for DIC
●ABG for metabolic acidosis
●Serum albumin
●ECG for cardiac dysrhythmias secondary to
hyperkalemia and hypocalcemia
20. Creatine Kinase Elevation
The standard biomarker
• Rise within 2 to 12 hours
• Maximum within 24 to 72 hours
• A decline within 3-5 days
NOT DECLINE AS EXPECTED
• Continued muscle injury
• Underlying muscle disease
• Compartment syndrome may be present
21. • Five times the upper limit of normal
• Range from approximately 1500 to over
100,000 units/L.
• Malignant Hyperthermia avg value 60,000
units/L.
22. PREHOSPITAL CARE
• Early and vigorous IV fluid resuscitation is the
most important treatment to prevent AKI
• Avoid potassium- or lactate-containing
solutions
• Preferred fluid is iv ns
23. EMERGENCY DEPARTMENT CARE
• Proper history
• Ask for co morbidities / medications
• Vitals
• ECG monitoring
• Catheterisation
• Basic investigation including electrolytes
24. • Continue aggressive IV rehydration.
• IV crystalloids infusion of 4 ml/kg/h
• Goal of maintaining a minimum urine output
of 200 to 300 ml/ hour.
25. • No Ideal fluid
• Urine alkalinization (sodium bicarbonate)
• Forced diuresis (mannitol or loop diuretics)
• CK >10000...Mannitol& Bicarbonates
26. • Hypocalcemia – no treatment needed
• IV-Calcium - hyperkalemia-induced
cardiotoxicity
Hyperkalemia
• Insulin - glucose therapy may not be effective.
• The use of ion-exchange resins (e.g., sodium
polystyrene sulfonate) may be effective.
27. • hyperphosphatemia - oral phosphate binders
when serum levels are >7 milligrams/Dl
• Avoid prostaglandin inhibitors such as NSAIDs
because of their vasoconstrictive effects on
the kidney.
• Treat the underlying cause
