QuestionSBA
QuestionChoice
This is incorrect. Although the patient is suffering from an AKI, the underlying cause is rhabdomyolysis.
10027619
d
Acute kidney injury
QuestionChoice
This is the correct answer. The patient is at risk of this condition due to her fall with a long lie. Rhabdomyolysis occurs when skeletal muscle is injured and rapidly breaks down, causing the release of intracellular myoglobin and potassium. It can present with muscle pain and swelling, red/brown urine and acute kidney injury. Treatment is mostly supportive with intravenous fluids and hyperkalaemia correction.
10027616
a
Rhabdomyolysis
QuestionChoice
This is incorrect. Although the patient is suffering from pain and swelling in their lower limb, a deep vein thrombosis would not cause so significant a rise in creatinine kinase. Furthermore, the negative d-dimer makes a deep vein thrombosis extremely unlikely.
10027618
c
Deep vein thrombosis
QuestionChoice
This is incorrect. Although the patient presented with a swollen and painful calf, there is no paralysis and peripheral pulses are palpable. The acute kidney injury along with the markedly raised creatinine kinase points towards an underlying diagnosis of rhabdomyolysis.
10027617
b
Compartment syndrome
QuestionChoice
This is incorrect. This would not account for the extremely high creatinine kinase and acute kidney injury, and would not be expected to result from a fall with a long lie.
10027620
e
Myositis
Concept
Chapter
2693
4410
Rhabdomyolysis
Topic
142
Nephrology
17921
An 82 year old female is brought into the A&E department following a fall. The paramedics report she had been on the floor overnight for approximately 10 hours. The patient describes severe pain in her left leg, which she had been lying on.


On examination, the patient's left leg looks markedly swollen compared to her right. She can move her toes, and peripheral pulses are palpable. The patient is catheterised and her urine appears dark and tea-coloured.


Blood results are as follows:


||||
|---------------------------|:-------:|--------------------|
|Sodium|135 mmol/L|135 - 145|
|Potassium|6.2 mmol/L|3.5 - 5.3|
|Urea|8.1 mmol/L|2.5 - 7.8|
|Creatinine|170 µmol/L|60 - 120|
|Creatine Kinase|5100 U/L|(M) 25 - 200, (F) 25 - 175|

D-dimer is negative.


Which of the following is the most likely diagnosis?
a