eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Rhabdomyolysis: Follow-up

Author: Sandy Craig, MD, Adjunct Associate Professor, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Carolinas Medical Center
Contributor Information and Disclosures

Updated: Oct 1, 2009

Follow-up

Further Inpatient Care

  • Admit patients with rhabdomyolysis for continued volume support and urinary alkalinization. Obtain serial CK measurements to verify that values have peaked and are returning to reference range.
  • Serial physical examinations and laboratory studies are indicated to monitor for compartment syndrome, hyperkalemia, acute oliguric or nonoliguric renal failure, and DIC.
  • In patients with no apparent precipitating factors for rhabdomyolysis, consider inherited disorders of carbohydrate or lipid metabolism and myopathies.

Transfer

  • Patients may be transferred to another facility after establishing intravenous access and addressing life- and limb-threatening conditions. Follow guidelines of the Consolidated Omnibus Budget Reconciliation Act (COBRA) and the Emergency Medical Treatment and Labor Act (EMTALA).

Complications

  • Death from hyperkalemia or renal failure
  • Compartment syndrome
  • DIC
  • Hepatic insufficiency
  • Acute renal failure

Prognosis

  • The prognosis is dependent upon the underlying etiology and any existing comorbidities.

Patient Education

  • Advise patients with rhabdomyolysis caused by hyperthermia and/or inordinate exertion to exercise in moderation with careful attention to hydration and external methods of cooling.
  • Advise patients with rhabdomyolysis related to ethanol, recreational drugs, or prescription medications to discontinue use of the offending agent and refer them to a rehabilitation program.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize rhabdomyolysis on initial presentation
  • Failure to institute early and aggressive volume replacement
  • Insufficient monitoring for serious complications, such as compartment syndrome and severe hyperkalemia
 


More on Rhabdomyolysis

Overview: Rhabdomyolysis
Differential Diagnoses & Workup: Rhabdomyolysis
Treatment & Medication: Rhabdomyolysis
Follow-up: Rhabdomyolysis
References
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Further Reading

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Contributor Information and Disclosures

Author

Sandy Craig, MD, Adjunct Associate Professor, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Carolinas Medical Center
Sandy Craig, MD is a member of the following medical societies: Alpha Omega Alpha and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Lance W Kreplick, MD, MMM, FAAEM, FACEP, Medical Director of Hyperbaric Medicine, Fawcett Wound Management and Hyperbaric Medicine; Consulting Staff in Occupational Health and Rehabilitation, Company Care Occupational Health Services; President and Chief Executive Officer, QED Medical Solutions, LLC
Lance W Kreplick, MD, MMM, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physician Executives
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Tom Scaletta, MD, President, Emergency Excellence (EmEx) (www.emergencyexcellence.com); Assistant Professor of Emergency Medicine, Rush Medical College, Cook County Hospital; Chairperson, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine
Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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