Is there a link between elevated Creatine Kinase (CK) levels after a fall and prolonged stay on the ground, and the development of rigidity and hyperreflexia?

From the Guidelines

Yes, there is a link between elevated creatine kinase (CK) levels after a fall with prolonged immobility and the development of rigidity and hyperreflexia. When someone falls and remains on the ground for an extended period, muscle damage can occur due to pressure and lack of movement, leading to rhabdomyolysis. This condition causes muscle breakdown and release of CK into the bloodstream. CK levels typically rise within 12 hours of injury and may peak at 24-72 hours. Significantly elevated CK (>1,000 U/L) can indicate serious muscle damage. The muscle breakdown products can cause neuromuscular complications including rigidity and hyperreflexia, particularly as the condition progresses. These symptoms may result from electrolyte imbalances (especially calcium, potassium, and phosphate abnormalities) that affect nerve and muscle function.

Key Considerations

• Elevated CK levels can be associated with an increased risk of acute kidney injury, as noted in a study published in 2021 1.
• The interpretation of CK levels is not straightforward and can be influenced by various factors such as ethnicity, body composition, and exercise intensity, as discussed in a 2023 study 1.
• Treatment involves aggressive IV fluid hydration, monitoring electrolytes, treating imbalances, and maintaining urine output above 200 mL/hour to prevent kidney damage.
• Patients with CK levels above 5,000 U/L after falls with prolonged immobility should be hospitalized for monitoring and treatment to prevent complications like acute kidney injury and neuromuscular symptoms.

Clinical Implications

• It is essential to consider the individual's overall clinical presentation, including their medical history, physical examination, and laboratory results, when interpreting CK levels.
• A multifaceted approach to falls prevention and management is crucial, as highlighted in a 2023 systematic review 1.
• Geriatric patients who present to the ED after a fall require a thorough assessment for traumatic injuries, as well as an evaluation of the cause of the fall and an estimation of future fall risk, as emphasized in the 2014 geriatric emergency department guidelines 1.

From the Research

Elevated Creatine Kinase Levels and Rhabdomyolysis

• Elevated serum creatine kinase (CK) levels can occur due to various reasons, including muscle damage, seizures, and physical exertion 2, 3, 4.
• Rhabdomyolysis, a condition characterized by muscle breakdown, can lead to elevated CK levels and acute kidney injury 4, 5, 6.
• The development of rigidity and hyperreflexia is not directly linked to elevated CK levels after a fall and prolonged stay on the ground in the provided studies.

Risk Factors and Complications

• Trauma is a common cause of rhabdomyolysis, and elevated CK levels can increase the risk of acute kidney injury 4, 5.
• Patients with underlying conditions, such as Huntington's disease, may be at higher risk of developing rhabdomyolysis-induced acute kidney injury 6.
• Complications of rhabdomyolysis include acute kidney insufficiency, irregular heart rhythm, and death 4.

Treatment and Management

• Aggressive hydration, fluid resuscitation, and electrolyte balance are crucial in managing patients with elevated CK levels and rhabdomyolysis 2, 4, 6.
• The use of bicarbonate and mannitol to prevent renal failure in patients with rhabdomyolysis is not supported by sufficient evidence 5.
• Continuous renal replacement therapy may be necessary in severe cases of rhabdomyolysis-induced acute kidney injury 6.