Diagnostic tests used in the evaluation of rhabdomyolysis | |
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General examination | Assess the level of consciousnessCheck for signs of:
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History | Check medication use62
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Vital signs | Check for signs of hypovolaemia and shock |
Serum CK | Elevated as a result of muscular damage: >5, >10, >20 or even >50 times the ULN |
Serum potassium | Elevated levels indicate muscular damage and potassium leakage from cells Hyperkalaemia increases the patient's risk for dysrhythmias |
Serum sodium | Check for exercise-associated hyponatraemia |
Renal function | Blood urea nitrogen and serum creatinine—assess renal function and hydration status. An elevated ratio may suggest dehydration, and an elevated creatinine level may suggest renal dysfunction. |
Myoglobinuria | Presence of urine myoglobin suggests muscular damage Absence of urine myoglobin does not preclude exertional rhabdomyolysis (optional; CK levels are normally used to guide management) |
Acid base status | Check for metabolic acidosis |
Coagulation tests | Abnormal results may indicate disseminated intravascular coagulation |
ECG | Check for dysrhythmias if the patient has hyperkalaemia or other electrolyte abnormalities |
Cardiac isoenzymes | Rule out cardiac infarction |
Toxicology screening | Check blood and urine for (illicit) drug abuse |
Risk assessment | Use the ‘Risk prediction score for kidney failure or mortality in rhabdomyolysis’ by McMahon et al.28 |
CK, creatine kinase; ULN, upper limit of normal.