Rhabdomyolysis with AKI risk — FFICM MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRenal and MetabolicRhabdomyolysis with AKI riskFFICM

A 34-year-old man is admitted after being trapped under rubble for 5 hours. CK is 86,000 IU/L, potassium is 5.7 mmol/L and creatinine is 148 micromol/L. Urine is dark and dipstick is positive for blood with few red cells on microscopy. There is no pulmonary oedema. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: A — Give isotonic crystalloid resuscitation and monitor potassium closely

C (Give isotonic crystalloid resuscitation and monitor potassium closely) is correct because this man has crush syndrome with rhabdomyolysis (CK 86,000 IU/L), pigment-induced AKI (dark urine, blood-positive dipstick with few red cells indicating myoglobinuria rather than haematuria), and dangerous hyperkalaemia (5.7 mmol/L) after prolonged entrapment. UK crush injury consensus guidance recommends early, generous isotonic crystalloid (0.9% saline) infusion to restore renal perfusion, increase glomerular filtration, and flush myoglobin from the tubules, titrated against urine output and cardiovascular status rather than a fixed restrictive volume. Because reperfusion after prolonged compression classically precipitates further potassium release and cardiac risk, serial potassium and ECG monitoring alongside fluids is mandatory, with treatment escalation (calcium, insulin/dextrose, dialysis) reserved for refractory hyperkalaemia or established renal failure, not applied pre-emptively. There is no pulmonary oedema here, so aggressive volume resuscitation is safe and indicated rather than contraindicated.

Reference: Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh, Consensus Statement on the Pre-Hospital Management of Crush Injury, May 2025, https://fphc.rcsed.ac.uk/media/3912/crush-consensus-fphc_fw.pdf