Summary
Definition
History and exam
Key diagnostic factors
- recent crush injury
- prolonged immobilisation
- presence of other risk factors
- muscular pain
Other diagnostic factors
- general malaise
- dark urine
- muscular swelling
- muscular tenderness
- diminished peripheral pulse
- prolonged capillary refill
Risk factors
- trauma
- alcohol
- cocaine
- amfetamine
- phencyclidine
- narcotics
- diuretics
- statins
- salicylate toxicity
- toxins
- envenomation
- inflammatory disorders
- muscle hypoxia
- genetic disorders
- metabolic disorders
- infection
- increased body temperature
- antipsychotics
Diagnostic investigations
1st investigations to order
- serum creatine kinase (CK) level
- serum electrolytes
- renal function
- liver function
- FBC
- coagulation studies
- urine dipstick
- urine microscopy
- myoglobin levels
Investigations to consider
- muscle biopsy
- thyroid-stimulating hormone
- erythrocyte sedimentation rate
- antinuclear antibodies
- toxicology screen
Treatment algorithm
crush injury and/or creatine kinase >5 times normal
anuric or unresponsive to hydration therapy
Contributors
Authors
Chinmay Patel, MD, FASN
Clinical Professor of Nephrology
University of Pikeville
Kentucky College of Osteopathic Medicine
Pikeville Medical Center
Pikeville
KY
Disclosures
CP is an author of one reference cited in this topic.
Aditya Kadiyala, MD, MPH
Vice Chair
Department of Medicine
Division of Nephrology
University of Maryland
Charles Regional Medical Center
La Plata
MD
Disclosures
AK declares that he has no competing interests.
Acknowledgements
Dr Chinmay Patel and Dr Aditya Kadiyala would like to gratefully acknowledge Dr Mark Shapiro, Dr Courtney Sommer, and Dr Robert D. Mathis, previous contributors to this topic.
Disclosures
MS is an author of references cited in this topic. CS and RDM declare that they have no competing interests.
Peer reviewers
Timothy Albertson, MD, PhD, MPH
Chief
Division of Pulmonary and Critical Care Medicine
University of California, Davis
Sacramento
CA
Disclosures
TA declares that he has no competing interests.
Differentials
- Myocardial infarction
- Influenza
- Fibromyalgia
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