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Rhabdomyolysis AKI — ESENeph MCQ

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EasyAcute Kidney InjuryRhabdomyolysis AKIESENeph

A 25-year-old man is brought to ED after being found collapsed. Bloods show: Na+ 128 mmol/L, K+ 7.8 mmol/L, urea 45 mmol/L, creatinine 1200 umol/L, bicarbonate 8 mmol/L, glucose 5.2 mmol/L, CK 85000 U/L. ECG shows broad QRS complexes. After calcium gluconate and insulin/dextrose, what is the definitive management?

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Correct answer: C — Emergency haemodialysis

This patient has rhabdomyolysis-induced AKI with life-threatening hyperkalaemia (K+ 7.8 with ECG changes), severe metabolic acidosis (bicarb 8), and uraemia (urea 45). Despite initial temporising measures (calcium gluconate for cardiac protection, insulin-dextrose for potassium shift), definitive management requires emergency haemodialysis for potassium and uraemic solute removal, and acid-base correction. IV fluids alone will be insufficient given the severity.

Reference: KDIGO 2012 – AKI Guideline; UK Renal Association 2020 – AKI Guideline