skip to main content

Rhabdomyolysis-associated AKI — ESENeph MCQ

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

HardAcute Kidney Injury, Electrolytes and Acid-BaseRhabdomyolysis-associated AKIESENeph

A 31-year-old man is found after lying on the floor overnight following a seizure. Creatinine is 188 micromol/L, potassium 5.7 mmol/L and creatine kinase is 96,000 IU/L. Urine dipstick shows blood 3+ but microscopy shows few red cells. Blood pressure is 108/64 mmHg and he is not fluid overloaded. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: C — IV crystalloid with electrolyte and volume monitoring

The dipstick-positive blood with few red cells and very high creatine kinase indicates rhabdomyolysis with myoglobinuric AKI risk; early isotonic crystalloid resuscitation is central when not fluid overloaded. Furosemide does not replace volume repletion and is not primary therapy. Renal biopsy is not indicated when the cause is evident. The pearl is that potassium can rise rapidly in rhabdomyolysis, so repeated monitoring and ECG assessment are essential. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: NICE NG148; KDIGO AKI Guideline: https://www.nice.org.uk/guidance/ng148/chapter/recommendations