From the Research
Management for a creatine kinase (CK) level of 900 U/L requires immediate attention to prevent complications, with a focus on identifying and treating the underlying cause, ensuring adequate hydration, and monitoring renal function. The initial steps should include discontinuing any potentially causative medications, such as statins, and ensuring adequate hydration with intravenous fluids, typically normal saline at 150-200 mL/hour, as well as monitoring renal function with daily creatinine measurements 1. Pain control may be necessary using acetaminophen or, if severe, opioids, while avoiding NSAIDs due to potential kidney injury. Regular CK level monitoring every 24-48 hours is recommended until levels trend downward. If rhabdomyolysis is suspected, maintaining urine output above 200 mL/hour and possibly alkalinizing urine with sodium bicarbonate may be indicated, as suggested by recent studies on the benefits of sodium bicarbonate in improving kidney function and muscle mass in patients with chronic kidney disease 2.
Key considerations in the management include:
- Identifying and addressing the underlying cause of the elevated CK level, whether medication-related, trauma, excessive exercise, metabolic disorders, or inflammatory myopathies.
- Preventing complications such as acute kidney injury, compartment syndrome, and electrolyte abnormalities.
- Monitoring urine output and electrolytes, and using urine osmolality and electrolytes in the clinical diagnosis of fluid, electrolytes, and acid-base disorders, as discussed in 3.
- Considering the potential benefits and risks of sodium bicarbonate treatment, including its effects on kidney function and muscle mass, as well as the potential for elevated systolic blood pressure, as noted in 2.
Given the potential for significant muscle damage and the release of myoglobin, which can precipitate in kidneys and cause acute kidney injury, prompt and thorough management is crucial to prevent morbidity and mortality, and to improve quality of life. Specialist consultation may be required for severe cases or those with complications. The approach to asymptomatic CK elevation, as outlined in 1, also emphasizes the importance of a systematic approach to diagnosis and management.