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Exertional rhabdomyolysis with acute kidney injury — SCE Acute Medicine MCQ

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ModerateAcute Renal and Metabolic EmergenciesExertional rhabdomyolysis with acute kidney injurySCE Acute Medicine

A 31-year-old man is admitted after a marathon with severe thigh pain and cola-coloured urine. CK is 84,000 IU/L, creatinine 188 micromol/L, potassium 5.8 mmol/L and urine dip is positive for blood but microscopy shows few red cells. What is the most appropriate next step in management?

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Correct answer: B — Start aggressive intravenous crystalloid resuscitation with electrolyte monitoring

The very high CK, AKI and myoglobinuria indicate rhabdomyolysis, where early IV fluids reduce pigment-associated kidney injury. Fluid restriction worsens renal risk unless pulmonary oedema develops. Diuretics are not a substitute for adequate volume resuscitation. Hyperkalaemia must be monitored and treated promptly if it worsens or ECG changes appear.

Reference: NICE CKS rhabdomyolysis, BNF