Rhabdomyolysis laboratory findings: Difference between revisions
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==Laboratory Findings== | ==Laboratory Findings== | ||
The approach to the evaluation of rhabdomyolysis is as follows: | |||
* Minimum Evaluation | * '''Minimum Evaluation''' | ||
** Etiology certain: | ** Etiology certain: | ||
*** CBC (complete blood count) | *** CBC (complete blood count) | ||
Line 25: | Line 14: | ||
*** Urine pH | *** Urine pH | ||
** Consider looking for [[hypothyroidism]] and sickle cell trait. | ** Consider looking for [[hypothyroidism]] and sickle cell trait. | ||
* Extensive Evaluation: | * '''Extensive Evaluation:''' | ||
** If etiology is uncertain, can | ** If etiology is uncertain, the following labs can be checked: | ||
*** [[Thyroid stimulating hormone]] | *** [[Thyroid stimulating hormone]] | ||
*** Erythrocyte glycolytic enzymes | *** Erythrocyte glycolytic enzymes | ||
Line 32: | Line 21: | ||
*** Serum [[carnitine]] | *** Serum [[carnitine]] | ||
*** Organic acids in urine. | *** Organic acids in urine. | ||
* '''Urinalysis''' | |||
** Blood (+) | |||
** No red blood cells on microscopy. This situation is either hemoglobin in the urine or myoglobin. The serum will be pink with hemoglobinuria. | |||
* '''Serum Markers''' | |||
** Elevated serum creatinine kinase | |||
*** CK elevation: Generally accepted > 5 times normal. Corresponds to about 200g of muscle. | |||
*** Begins to rise 2-12 hrs after onset. Peaks 1-3 days in. Declines 3-5 days after the process stops. | |||
** [[Myoglobin]] | |||
*** Myoglobin: Starts earlier than CK but clears faster, so serum and urine myoglobin useful early in course of the disease. Myoglobin is eventually urinated and/or converted to [[bilirubin]]. | |||
*** All myoglobinuria is caused by rhabdomyolysis, but not all rhabdomyolysis causes myoglobinuria. Urine changes color when > 1mg/ml. | |||
** LDH ([[lactic dehydrogenase]]) | |||
==References== | ==References== |
Latest revision as of 14:31, 22 April 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Laboratory Findings
The approach to the evaluation of rhabdomyolysis is as follows:
- Minimum Evaluation
- Etiology certain:
- CBC (complete blood count)
- CK
- Chemistries
- Liver function tests
- Urine pH
- Consider looking for hypothyroidism and sickle cell trait.
- Etiology certain:
- Extensive Evaluation:
- If etiology is uncertain, the following labs can be checked:
- Thyroid stimulating hormone
- Erythrocyte glycolytic enzymes
- CPT I/II in leukocytes
- Serum carnitine
- Organic acids in urine.
- If etiology is uncertain, the following labs can be checked:
- Urinalysis
- Blood (+)
- No red blood cells on microscopy. This situation is either hemoglobin in the urine or myoglobin. The serum will be pink with hemoglobinuria.
- Serum Markers
- Elevated serum creatinine kinase
- CK elevation: Generally accepted > 5 times normal. Corresponds to about 200g of muscle.
- Begins to rise 2-12 hrs after onset. Peaks 1-3 days in. Declines 3-5 days after the process stops.
- Myoglobin
- Myoglobin: Starts earlier than CK but clears faster, so serum and urine myoglobin useful early in course of the disease. Myoglobin is eventually urinated and/or converted to bilirubin.
- All myoglobinuria is caused by rhabdomyolysis, but not all rhabdomyolysis causes myoglobinuria. Urine changes color when > 1mg/ml.
- LDH (lactic dehydrogenase)
- Elevated serum creatinine kinase