Rhabdomyolysis

[julz68]

Can someone explain what exactly this entails? I'm a new grad fresh off orientation (2 months) and had a pt with this condition last noc. He also had a hx of CHF and had NS running at 200/hr. I was really nervous about the fluid rate since he did have CHF and his output (he had a Foley) was only 475mL my entire 12 hr shift. I assessed his lung sounds q2° because I was afraid of fluid overload. His lungs remained clear throughout my shift, thank God, but I'm just curious, is that a normal fluid rate for someone with rhabdo and a hx of CHF?

I discussed it with my CN and she just said to keep a close eye on his lung sounds, but didn't really offer any more insight into the disease process.

I work again tonight and more than likely will have this pt again. I just want to know more about what else I should be on the lookout for since this is the first time I've had this type of pt.

Thanks :)

[julz68]

Don't leave! I've been posting here for years and had the same thing happen to me today. I thought your question was interesting...if you had googled it, I'll wager you'd end up back here anyway, right?

Actually that's exactly what happened. Looked it up at work. Ha!

Just wanted more insight from other more experienced nurses. After all, that's what I thought the whole purpose of the AN community was for. Oh well...

*sigh*

[Hoozdo, ADN]

Here is some medical trivia to lighten things up. If you work in correctional nursing you see this rhabdo diagnosis quite frequently. The prisoners are so bored they have exercise contests and the winners get a trip to the infirmary for IV fluids!

[chrisrn24]

Sometimes it is hard to google a certain question so it is great to ask here!

[OCNRN63, RN]

You're so funny! Haha!

With all due respect, I did look it up. My question was about the fluid rate with CHF.

It seems like every time I ask for advice lately, I usually get someone who wants to shoot me down and make me feel like an idiot.

Think I will take a break from this site for a while.

It was a good question, and you're not an idiot. Ignore the sarcasm. I had a patient many years ago who had neuroleptic malignant syndrome and had rhabdo.

Please reconsider taking a break; there are many people here who are more than willing to help share experiences. It's all part of passing experience along to newer nurses.

[Esme12, ASN, BSN, RN]

Actually that's exactly what happened. Looked it up at work. Ha!

Just wanted more insight from other more experienced nurses. After all, that's what I thought the whole purpose of the AN community was for. Oh well...

*sigh*

I have used Let me google that for you as a search engine as it yields good results. It doesn't mean that someone was being mean to you.....((HUGS)).

Patients with Rhabdomyolysis have literally, “dissolution of skeletal muscle”. This is a syndrome caused by injury to skeletal muscle and involves leakage of large quantities of potentially toxic intracellular contents into plasma. In adults, rhabdomyolysis is characterized by the triad of muscle weakness, myalgias, and dark urine. Life-threatening renal failure and disseminated intravascular coagulation (DIC) are dreaded complications that appear to be more common in adults.

Rhabdomyolysis has many etiologies and is often multifactorial in adult patients. Muscle destruction can come from injury....crush, falls, large trauma, long time lying on the floor, inflammatory disease of the muscle, excessive exercise, and certain meds.

Management of rhabdomyolysis consists primarily of correction of fluid and electrolyte anomalies. High CPK level indicates muscle destruction and the myoglobin (fat globules) "clog" up the kidneys and cause renal failure. Flushing out of these "bad" by products of muscle destruction.

The actual balance is a tricky one and the patient needs close monitoring in the presence of CHF but many of these patients are dehydrated from long unattended down times and could use the fluids. This is a common scenario with elderly falls.

Here are some great articles information.....Rhabdomyolysis - March 1, 2002 - American Family Physician

Rhabdomyolysis

[RNitis]

With all due repect we all have to research and look up information throughout our life...so let me google that for you. :)

Let me google that for you[/quote

It still amazes me how condescending people are on this site. We are here to share experience, insight and stories. There's always that one person who just has to comment who would've left us all in a better state if they just moved along, instead of being rude. Did nobody watch Bambi as a child?! Pretty simple words from Thumper: "If u can't say something nice, don't say anything at all!"

[RNitis]

It was a good question, and you're not an idiot. Ignore the sarcasm. I had a patient many years ago who had neuroleptic malignant syndrome and had rhabdo.

Please reconsider taking a break; there are many people here who are more than willing to help share experiences. It's all part of passing experience along to newer nurses.

Don't mind some of the people on here, really...this site has alot of great nurses who want to share their stories and experiences..I've also stoppped posting bc there's always that one person who has to turn the mood negative..just ignore them. Take what you can use and leave the rest!

[MauraRN]

I had a middle-aged CHFr with rhabdo as a s/e of a statin med. By the time the doc made the dx, pt was in ARF, we were pumping him full of fluid at 300ml/hr despite the CHF. He recovered slowly. I think you asked a terrific question and it sounds like you provided proper care and assessment, your nursing gut told you to watch the lungs, you were right on.

[KJM-RN, BSN]

Just thought I'd add that Rhabdomylosis can be a serious complication from statin medications, as was the case for a patient I assisted with during my first semester of nursing school.

[That Guy, BSN, RN, EMT-B]

Reading this i seriously wonder how my pt with Rhabdo is doing since we sent him home instead of admitting him. I did not like it at all and charted my butt off on him but I guess we will see if his kidneys shut down sometime soon.

[julz68]

Don't mind some of the people on here, really...this site has alot of great nurses who want to share their stories and experiences..I've also stoppped posting bc there's always that one person who has to turn the mood negative..just ignore them. Take what you can use and leave the rest!

Thanks! Yeah, there seems to always be one that has a snarky remark. I just tend to take things to heart more often than not.

I do value the advice and opinions of seasoned nurses on here tho, so I guess I will have to just ignore the ones who try and make me feel bad and concentrate on the replies from those who want to help. It's hard enough to be a new nurse wanting to learn when some people go out of their way to make you feel like a total idiot! Ha!

[julz68]

I had a middle-aged CHFr with rhabdo as a s/e of a statin med. By the time the doc made the dx pt was in ARF, we were pumping him full of fluid at 300ml/hr despite the CHF. He recovered slowly. I think you asked a terrific question and it sounds like you provided proper care and assessment, your nursing gut told you to watch the lungs, you were right on.[/quote']

Thank you!

My pt is recovering slowly as well. His out put is getting better, but I had to call last night to decrease his fluids a bit because he was starting to show signs of CHF. He was having expiratory wheezes anteriorly and crackles in the bases posteriorly. Doc said to only decrease to 150/hr tho. He was at 200.

I have the next 2 nights off...I'm curious if he'll still be there when I return.