Rhabdomyolysis: An evidence-based approach

Area of Science:

• Geriatrics
• Nephrology
• Internal Medicine

Background:

• Elderly patients experiencing falls may present with complex medical conditions.
• Prolonged immobility can precipitate serious health complications.

Purpose of the Study:

• To report a case of severe rhabdomyolysis and acute kidney injury secondary to prolonged immobility and dehydration in an elderly female patient.
• To highlight the importance of early recognition and management of complications arising from falls in the elderly.

Main Methods:

• Case report of a 76-year-old female presenting after a fall and 18 hours of immobility.
• Clinical assessment including vital signs, hydration status, and laboratory investigations (creatinine kinase, renal function).
• Management included treatment for community-acquired pneumonia, fluid resuscitation, and management of hyperkalaemia, progressing to renal replacement therapy.

Main Results:

• The patient presented with dehydration, fever, tachycardia, and significantly elevated creatinine kinase (200,000 U/L), indicating severe rhabdomyolysis.
• Acute kidney injury (AKI) developed, characterized by deteriorating renal function, anuria, and fluid overload within 48 hours.
• The patient required renal replacement therapy (RRT) for management of AKI.

Conclusions:

• Falls in the elderly, especially when combined with underlying conditions like pneumonia and dehydration, can lead to severe complications such as rhabdomyolysis and AKI.
• Prompt recognition and aggressive management are crucial for patients with immobility-induced complications.
• This case underscores the need for vigilant monitoring and timely intervention in elderly patients following falls.