From the Guidelines
Rhabdomyolysis (rhabdo) is considered present when creatine kinase (CK) levels exceed 5 times the upper limit of normal, approximately 1000 IU/L, as indicated by elevated CPK levels above five times normal 1. This threshold is a critical marker for the diagnosis of rhabdomyolysis, particularly in patients with severe limb trauma. The guidelines for the acute care of severe limb trauma patients suggest that raising CPK levels above five times normal is a sign of rhabdomyolysis 1. Some key points to consider in the diagnosis and management of rhabdomyolysis include:
- CK levels above 75,000 IU/L are associated with a high incidence of newly formed acute kidney injury 1
- Myoglobin is responsible for intraluminal kidney tubular obstruction resulting in reduced glomerular filtration rate 1
- Measurement of plasma myoglobin may be more sensitive and specific than CPKs in identifying the risk of acute kidney injury 1
- Plasma potassium test for hyperkalaemia and a measurement of kidney function by means of plasma creatinine test can complement the assessment 1 It is essential to note that the diagnosis of rhabdomyolysis is not based solely on CK levels but also requires clinical symptoms and a history of potential triggers. Treatment involves aggressive IV fluid administration and monitoring of electrolyte abnormalities.
From the Research
Definition of Rhabdomyolysis
Rhabdomyolysis is a serious and potentially life-threatening condition characterized by the release of intracellular elements after the destruction of skeletal muscle 2, 3.
Creatine Kinase (CK) Levels
- CK levels are used for diagnosis and prognosis of rhabdomyolysis 2, 3.
- A reasonable definition of rhabdomyolysis is elevation of serum creatine kinase activity of at least 10 times the upper limit of normal 2.
- CK levels can range from 10,000 to 200,000 or even higher in rhabdomyolysis 4.
- Exceptionally high CK levels, such as nearly 1 million, can occur in massive rhabdomyolysis 4.
Complications and Treatment
- Acute renal failure is the most common complication of rhabdomyolysis, particularly if CK levels are >16,000 IU/l 2.
- Treatment is based on early and intensive fluid therapy to avoid kidney complications 3.
- Bicarbonate therapy is not recommended for the prevention of acute kidney injury (AKI) in rhabdomyolysis patients, as it may be associated with higher mortality and worse renal outcomes 5.
- High-volume fluid therapy may also be harmful, and limited use of bicarbonate and adjustment of fluid volume may improve outcomes 5.