Rhabdomyolysis: a number that does not carry the risk
Educational use only. Not clinically reviewed24-year-old man for Cause review, compartment examination, review of what the creatine kinase decides, qualified fluid ownership, reassessment, and handoff. About 60 simulated minutes.
What you will practise
- Establish the cause, because the cause is what the observed risk tracks.
- Examine for the one thing here that is time-critical and is not a number.
- Separate what the creatine kinase shows from what it decides.
- Distinguish supported care from familiar additions that are not established.
- Transfer with the cause, the examination, and the fluid ownership explicit.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- McMahon GM, Zeng X, Waikar SS. A risk prediction score for kidney failure or mortality in rhabdomyolysis. JAMA Internal Medicine. 2013;173:1821–1828. doi:10.1001/jamainternmed.2013.9774. Retrospective, two teaching hospitals in one city, restricted to a creatine kinase above 5,000 U/L within three days, so it says nothing about anyone below that. A C statistic of 0.82–0.83 is discrimination within the cohorts it was built and checked in, not a prediction for an individual, and the record lists two published comments on it.
- Sawhney JS, Kasotakis G, Goldenberg A, Abramson S, et al. Management of rhabdomyolysis: a practice management guideline from the Eastern Association for the Surgery of Trauma. The American Journal of Surgery. 2022;224:196–204. doi:10.1016/j.amjsurg.2021.11.022. The authors rate the quality of evidence very low, note that the vast majority of the literature is retrospective, and open by saying the treatment remains controversial. Absence of demonstrated benefit is not demonstrated absence of benefit, and that cuts against confidence in either direction.
- Oh RC, Arter JL, Tiglao SM, Larson SL. Exertional rhabdomyolysis: a case series of 30 hospitalized patients. Military Medicine. 2015;180:201–207. doi:10.7205/MILMED-D-14-00274. Thirty retrospective cases from a military population with trauma, toxin and heat illness excluded, so it generalises to almost nobody. The inverse correlation it reports between creatinine and creatine kinase is one finding in one small series and is not offered here as a rule.
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.