Acute Kidney Injury
Rhabdomyolysis

CK >5 times the upper limit of normal (typically >1,000 U/L), (intrarenal) AKI, specifically acute tubular necrosis (ATN) from myoglobin‑mediated tubular injury and renal ischemia

-- HPI: triad consists of myalgias, weakness, and dark urine (myoglobinuria) Symptoms typically develop over hours to days after an inciting event (*), Common etiologies include trauma, exertion, immobilization, drugs (especially statins, alcohol, illicit substances), infections, extreme temperatures, and metabolic/genetic disorders

— SHx:
-- Pertinent vitals/labs/imaging: baseline BUN/creatinine (10–15 → intrinsic (e.g., ATN from rhabdo)), CBC, BMP (HyperK,HyperPhos,HyperCa), elevated CK, AST>ALT with normal ALK Phos), GAP (elevated-AGMA) CK, UA (Hyaline cast prerenal, Muddy brown ATN,RBC cast GN,WBC casts onterstitial nephritis)(myoglobinuria without RBC <3) FeNa (<1% pre-renal->2% ATN) Less specific CKD, or FEUrea <35% (if on diuretics suggest pre-renal) Urine-Na (> 40 suggests ATN and < 20 suggests pre-renal)., Urine Cr,, renal US vs CTAP if c/f obstruction
-- pertinent medical and social Hx: CKD, CHF, cirrhosis, malignancy
-- pertinent Home meds: recent med changes (NSAIDs, ACE/ARB, abx, anticholinergics, PPI, allopurinol

PLan
-- LR 1–2 L bolus at first then rate of 200–500 mL/hr continuous
-- Fluids adjusted to urine output goal of 200-300 mL/hr until CK declines (monitor for volume overload while on fluids), Cr stable or improving, No ongoing myoglobinuria and Electrolytes normalized
-- monitor for volume overload, stop fluids when (pulmonary edema, >3–5 L positive balance), regardless of CK
-- f/u FeNa or FEUrea, Urine-Na (> 40 suggests ATN), Urine Cr
-- trend BMP q12h first then daily replete Lytes as needed
-- Daily BUN, Creatinine, and BMP and CK
-- replete Lytes as needed
-- strict I/O; daily weights
-- can stop fluids when CK downtrending (<5,000 U/L in most guidelines)
-- hold nephrotoxins, hold home ACE/ARB, diuretics
-- Telemetry;

Admission order: LR 1–2 L bolus at first then rate of 200–500 mL/hr continuous, CMP q12h first then daily, Urine-Na (> 40 suggests ATN and UNa < 20 suggests pre-renal), hold hold nephrotoxins, UA, EKG, telemetry, strict I/O,