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Soft Tissue Case 10 Diagnosis

The classic triad of rhabdomyolysis is myalgias, myoglobinuria, and elevated serum creatine phosphokinase(CK) following intense physical activity or injury. Marked elevation in serum CK is the hallmark diagnostic feature of rhabdomyolysis, rising within two to twelve hours after muscle injury and staying elevated for days. Although there is no absolute cutoff, a fivefold increase above the upper limit of normal or greater is a widely accepted criterion to make the diagnosis.

Classically the urine is dark because of myoglobinuria. Urine dipsticks do not test specifically for myoglobin but will react positively to both myoglobin and hemoglobin. The classic urinalysis result in rhabdomyolysis is a dipstick that is positive for blood with a microscopic analysis that is negative for RBCs because there is no actual hematuria in rhabdomyolysis. Urine myoglobin testing is not typically readily available during the ED course. Furthermore, caution should be taken interpreting the urinalysis - it can appear normal in up to 50% of cases because of rapid excretion of myoglobin.

Obtain an ECG due to electrolyte abnormalities, total CK, urinalysis, CBC, basic chemistry panel, magnesium, phosphorous, uric acid, and DIC panel.