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Rhabdomyolysis after long lie — SCE Geriatric Medicine MCQ

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HardAcute medical careRhabdomyolysis after long lieSCE Geriatric Medicine

An 89-year-old woman with severe frailty is found on the floor at home after lying there overnight. Temperature is 35.2°C, CK is 4200 IU/L, creatinine is 210 micromol/L from baseline 90 and urine dipstick is positive for blood without red cells. She is taking ramipril, furosemide and simvastatin. What is the most appropriate management?

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Correct answer: C — Treat rhabdomyolysis and AKI with careful fluids, monitoring and medicines review

A long lie with raised CK, AKI and dipstick blood without red cells indicates rhabdomyolysis with myoglobinuria. Treatment requires careful fluid resuscitation, electrolyte monitoring and review of nephrotoxic or contributory medicines, balanced against frailty and heart failure risk. Diuretics are not first-line for clearing myoglobin unless managing overload. The pearl is that a fall with long lie is an acute medical presentation, not solely a social problem.

Reference: NICE AKI NG148; BNF; BGS falls guidance