From the Guidelines
In patients with rhabdomyolysis, creatine kinase (CK) levels are typically considered diagnostic when exceeding 1,000 U/L, with levels above 5,000 U/L often indicating severe muscle damage 1. The magnitude of CK elevation often correlates with the extent of muscle damage, though it doesn't always predict clinical outcomes or complications like acute kidney injury.
- CK levels begin to rise within 2-12 hours of muscle injury, peak within 24-72 hours, and gradually decline over 3-5 days with appropriate treatment.
- Serial monitoring of CK levels is important to track the course of the condition, with decreasing levels suggesting improvement.
- Treatment focuses on aggressive intravenous fluid administration to prevent kidney injury, with a goal of producing 200-300 mL of urine per hour.
- CK levels should be monitored daily until they show a clear downward trend, as persistent elevation may indicate ongoing muscle damage requiring further investigation. In order to detect acute kidney injury in patients suffering from post-traumatic acute rhabdomyolysis after limb traumatic injury, it is probably recommended to perform: a repeated bio-assessment combining plasma myoglobin, plasma creatine phosphokinase (CPK) and kalaemia measurements 1.
- Bladder catheterisation to monitor hourly urine output and urine pH, which should be maintained at 6.5, is also recommended. The measurement of plasma myoglobin, which has an earlier peak plasma concentration than CPKs, may be more sensitive and specific than CPKs in identifying the risk of acute kidney injury, which is correlated with increased mortality 1.
From the Research
Rhabdomyolysis and CK Levels
- Rhabdomyolysis is a complex medical condition involving the rapid dissolution of damaged or injured skeletal muscle 2.
- The condition can be initiated by any form of muscle damage, and one of the most important treatment goals is avoiding acute kidney injury 2.
- However, there is no direct information available in the provided studies regarding the CK level in rhabdomyolysis.
Fluid Management in Critically Ill Patients
- Intravenous fluid administration is one of the most common interventions in the intensive care unit, and critically ill patients have dynamic fluid requirements 3, 4.
- The management of fluid therapy is challenging, and new literature suggests that balanced salt solutions may be preferred in some patient populations 3.
- The selection and monitoring of intravenous fluid therapy are crucial, as inappropriate use of fluids can have detrimental effects 3, 4.
Relevance to CK Levels in Rhabdomyolysis
- Unfortunately, the provided studies do not directly address the topic of CK levels in rhabdomyolysis.
- The studies focus on fluid management in critically ill patients, rhabdomyolysis in general, and treatment of photodamaged skin, but do not provide specific information on CK levels in rhabdomyolysis.