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Acute kidney injury from rhabdomyolysis — ABIM Board MCQ

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HardNephrologyAcute kidney injury from rhabdomyolysisABIM Board

A 37-year-old is found after prolonged immobilization with CK 96,000 U/L, potassium 6.1 mEq/L, creatinine 2.3 mg/dL and hypotension. ECG shows peaked T waves. Which immediate sequence is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Give IV calcium with intracellular potassium shifting and isotonic crystalloid resuscitation

The best answer is “Give IV calcium with intracellular potassium shifting and isotonic crystalloid resuscitation”. ECG-toxic hyperkalemia requires immediate membrane stabilization and intracellular shifting, while hypotensive rhabdomyolysis requires prompt isotonic volume resuscitation. Routine bicarbonate or forced diuresis is not a substitute for these time-critical measures, and testing must not delay treatment.

Reference: KDIGO Clinical Practice Guideline for Acute Kidney Injury: https://kdigo.org/guidelines/acute-kidney-injury/