Author(s) Rana A.; Iqbal A.; Mustafa M.; Tahir S.
Institution(s) (Rana, Iqbal, Mustafa) GME, Nazareth Hospital, Philadelphia, PA, United States
(Tahir) Royal Blackburn Hospital, Blackburn, Lancashire, United Kingdom
Source Journal of General Internal Medicine; 2021; vol. 36
AbstractLEARNING OBJECTIVE #1: Recognising when to order CPK levels in patients with atypical presentations of rhabdomyolisis. LEARNING OBJECTIVE #2: Association of rhabdomyolysis with elevation in LFTs. CASE: A 26-year-old healthy caucasian female with no significant past medical history presented to the Emergency Department with complaints of three days of worsening bilateral lower extremity myalgia. After three months of relativly low physical activity, the patient decided to get back into shape, she started crossfit, and the next day completed a 3 mile hike even though she was sore from the previous day's workout. One day prior to presentation, the patient visited a different ED where they completed a doppler ultrasound of her bilateral lower extremities and after it was negative for DVT, discharged her with analgesics. The patient has never had symptoms like this in the past, has never been tested for metabolic disorders, is currently not on any medication, and denies alcohol or drug abuse. In the ED: CBC and BMP was unremarkable, myoglobinuria was present, CPK was 18760. AST 390 ALT 132, Creatinine within normal limits. Patient was subsiquently started on IV fluids. an ultrasound of the abdomen was done, the liver was unremarkable. Once the Patient's CPK decreased to more acceptable limits and her lower extremity myalgia resolved, she was discharged with lab work and a PCP followup in 3 days.
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