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Elevated AST – muscle source — RACP Paediatrics MCQ

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HardGIElevated AST – muscle sourceRACP Paediatrics

A 15-year-old presents after an intense exercise challenge with myalgia, cola-coloured urine, CK 48,000 U/L, potassium 5.8 mmol/L and rising creatinine. There is no compartment syndrome. Which management priority best limits preventable complications?

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Correct answer: A — Begin monitored isotonic intravenous fluid and serial electrolyte assessment

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as D · D = shown as E

C is correct. Severe rhabdomyolysis requires prompt isotonic fluid, close urine-output and renal monitoring, and repeated potassium, calcium and phosphate assessment. A routine bicarbonate-first strategy is unsupported and delays volume treatment. B increases pigment-associated kidney injury. D diuretics do not substitute for restoring perfusion and are not routine. E exercise-associated rhabdomyolysis does not require corticosteroid or acute muscle biopsy.

Reference: Queensland Children’s Hospital, Rhabdomyolysis emergency management in children: https://www.childrens.health.qld.gov.au/wp-content/uploads/PDF/guidelines/gdl-70028.pdf