Table 4

Assessment of risk of acute renal failure and other complications

Diagnostic tests used in the evaluation of rhabdomyolysis
General examinationAssess the level of consciousnessCheck for signs of:
  • Dehydration

  • Systemic infection

  • Trauma

  • Compartment syndrome

  • Exertion heat stroke

HistoryCheck medication use62
  • Antipsychotics (haloperidol, fluphenazine, perphenazine, chlorpromazine)

  • Cyclic antidepressants and selective serotonin reuptake inhibitors

  • Statins (atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin, cerivastatin)

  • Fibric acid derivatives (bezafibrate, clofibrate, fenofibrate, gemfibrozil)

  • Quinine

  • Salicylates

  • Theophylline

  • Antibiotics (fluoroquinolones, pyrazinamide, trimethoprim/sulphonamide, amphotericin B, itraconazole, levofloxacin)

  • Zidovudine

  • Antihistamines

  • Aminocaproic acid

  • Phenylpropanolamine

  • Sodium valproate

  • Anaesthesia with volatile anaesthetics a/o succinylcholine

  • Benzodiazepines

  • Corticosteroids

Vital signsCheck for signs of hypovolaemia and shock
Serum CKElevated as a result of muscular damage: >5, >10, >20 or even >50 times the ULN
Serum potassiumElevated levels indicate muscular damage and potassium leakage from cells
Hyperkalaemia increases the patient's risk for dysrhythmias
Serum sodiumCheck for exercise-associated hyponatraemia
Renal functionBlood 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.
MyoglobinuriaPresence 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 statusCheck for metabolic acidosis
Coagulation testsAbnormal results may indicate disseminated intravascular coagulation
ECGCheck for dysrhythmias if the patient has hyperkalaemia or other electrolyte abnormalities
Cardiac isoenzymesRule out cardiac infarction
Toxicology screeningCheck blood and urine for (illicit) drug abuse
Risk assessmentUse the ‘Risk prediction score for kidney failure or mortality in rhabdomyolysis’ by McMahon et al.28
  • CK, creatine kinase; ULN, upper limit of normal.