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Rhabdomyolysis-induced AKI — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesRhabdomyolysis-induced AKISCE Acute Medicine

A 24-year-old man is admitted after being found on the floor following a recreational drug binge. He has painful swollen thighs and dark urine. CK is 86,000 IU/L, creatinine is 192 micromol/L, potassium is 5.7 mmol/L and urine dipstick is positive for blood with no red cells on microscopy. What is the most appropriate next step in management?

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Correct answer: C — Aggressive intravenous crystalloid therapy with electrolyte monitoring

Marked CK elevation, myoglobinuria pattern and AKI indicate rhabdomyolysis requiring early IV crystalloid to reduce renal tubular injury and close electrolyte monitoring. Fluid restriction would increase AKI risk. Statins can cause rhabdomyolysis rather than treat it. The pearl is that dipstick blood without red cells suggests myoglobin or haemoglobin.

Reference: NICE CG169 AKI; UK Kidney Association AKI guidance