Summary
Definition
History and exam
Key diagnostic factors
- recent crush injury
- prolonged immobilisation
- presence of other risk factors
- muscular pain or weakness
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 or >1000 IU/L
acute kidney injury refractory to initial therapy
Contributors
Authors
Chinmay Patel, MD, FASN
Nephrology Specialist
East Texas Kidney Specialists
Longview
TX
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Kodadek L, Carmichael Ii SP, Seshadri A, et al. Rhabdomyolysis: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document. Trauma Surg Acute Care Open. 2022;7(1):e000836.Full text Abstract
The Renal Association (UK). Clinical practice guideline: acute kidney injury (AKI). Aug 2019 [internet publication].Full text
Sawhney JS, Kasotakis G, Goldenberg A, et al. Management of rhabdomyolysis: a practice management guideline from the Eastern Association for the Surgery of Trauma. Am J Surg. 2022 Jul;224(1 pt a):196-204.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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