" Total CK elevation is a
sensitive but nonspecific marker for rhabdomyolysis. Suspect early
rhabdomyolysis in patients with serum CK levels in excess of 2-3 times the
reference range and risk factors for rhabdomyolysis; initiate a full laboratory
workup.
(...)
In a 1988 review,
Ward suggested that predictors for the development of renal failure include peak
CK more than 6000 IU/L, dehydration (hematocrit >50, serum sodium >150
mEq/L, orthostasis, pulmonary wedge pressure <5 mm Hg, urinary fractional
excretion of sodium <1%), sepsis, hyperkalemia or hyperphosphatemia on
admission, and the presence of hypoalbuminemia. Acute renal failure has
occasionally developed in patients with peak CK as low as 2000 IU/L. To prevent
renal failure, many authorities advocate urine alkalinization, mannitol, and
loop diuretics."
Ward MM: Factors
predictive of acute renal failure in rhabdomyolysis. Arch Intern Med 1988 Jul;
148(7): 1553-7[Medline].
"Alkalinization of urine by the administration of intravenous bicarbonate has also been shown to be beneficial in nonrandomized studies. Alkalinization of the proximal tubular fluid pH by the administration of carbonic anhydrase inhibitor acetazolamide has not been shown to be beneficial consistently, however. The reason for this apparent discrepancy is not clear."
- RHABDOMYOLYSIS - Crit Care Clin. 1999 Apr;15(2):415-28, ix-x.
Martin Pham-Dinh
www.phamdinh.ca
De : [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] De la part de Martin Loranger
Envoy� : 29 septembre 2004 00:07
� : [EMAIL PROTECTED]
Objet : URG-L: CK et Trauma
Cas vu hier
H 32 ans, parfaite sant�
Accident camion lourd. Demi tonneau. Incarc�r� en
position bizarre (dont genou D en hyperflexion) pendant 3 1/2
heures. A senti sa jambe droite engourdie durant tout ce
temps.
2 probl�mes:
1.- Baisse importante sensibilit� et proprioception a/n pied
droit, surtout la plante. Baisse force extension cheville et gros orteil
(4/5). Pas de ROT achil�en. Plaie de pression genou droit. Pas
de fracture.
Questions: atteinte neurologique par anoxie? � quoi
ressemble l'�volution? Ne me semble pas un SPE (sciatique poplit� externe)
vue l'atteinte proprioceptive et absence ROT.
2.- Pic de CK � 13000. "By the book" une
rhabdomyolyse. Ce n'est pas surprenant vu le trauma par contre.
Questions: � combien traite-t-on plus
agressivement??? Croyez-vous � l'alcalinisation des urines
et/ou � la diur�se forc�e avec mannitol?
Martin Loranger MD
Urgence Charles LeMoyne
