Rhabdomyolysis

  1. 0 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
  2. Visit  julz68 profile page

    About julz68

    Joined Jan '13; Posts: 466; Likes: 374.

    26 Comments so far...

  3. Visit  CodeteamB profile page
    5
    Quote from 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
    In rhabdomyolysis the patient has some mechanism of muscle damage leading to waste products from cell destruction in the blood stream. The waste products, especially myoglobin are extremely hazardous to the kidneys. You need to keep the patient well hydrated as a buffer to this kidney damage, and these patients are often shocky as well.

    Yes, the CHF diagnosis is a consideration here, but it needs to be balanced with the patient's hydration status, otherwise now he has CHF and kidney failure. I have seen once (in a case with a large positive fluid balance) lasix prescribed as necessary.

    It sounds like you were using your head (watching the is and os and assessing for clinical status) that the patient remained stable and tolerated the fluid (and 200/h seems like a lot but it is really quite conservative for rhabdo).

    Hope that helps
    elprup, AJJKRN, WeepingAngel, and 2 others like this.
  4. Visit  PediLove2147 profile page
    0
    200 ml/hr is normal for that diagnosis. I had a patient getting 250 ml/hr so comparable. Like the PP stated, you need to keep the kidneys flushed so the high fluid rate is necessary. You did the right thing with your assessment. My patient was only 21 with no PMH so I didn't have the same considerations.
  5. Visit  Fiona59 profile page
    1
    The only time I've ever seen a this was in a patient who was tazered.
    Esme12 likes this.
  6. Visit  WoundedBird profile page
    1
    It can also been seen in athletes who train too hard (there was a college FB program a few years back that made the news). Also, I'm thinking that severe trauma can lead to rhabdo but I'm not 100% certain on it. If someone can confirm or deny that for me that would be amazing.
    Esme12 likes this.
  7. Visit  CodeteamB profile page
    2
    Yup, trauma, overtraining (weekend warriors), drug overdoses, little old ladies who have fallen and can't get up. Crush injuries are particularly problematic but anything that causes sufficient muscle damage can cause rhabdo.
    That Guy and Esme12 like this.
  8. Visit  WoundedBird profile page
    1
    Thanks CodeteamB for the confirmation!
    Esme12 likes this.
  9. Visit  GrnTea profile page
    0
    Yeah, the myoglobin from crushed or necrotic muscle cells clogs up them teeny renal parts something fierce-- did you notice that brownish urine? Gotta keep 'em flushing out. Sure, your CHFr needs careful watching (you did that, way to go!) but he doesn't need ARF in addition to his CHF. Vitamin L (Lasix) helps a lot.

    For what it's worth, hemolysis (like what happens when you give the wrong flavor of blood products or certain poisons) releases hemoglobin into the serum, freed from its little RBC envelopes. Same thing happens to the kidneys-- gotta keep 'em flushed. Lots of fluid and Vitamin L prn.
  10. Visit  julz68 profile page
    1
    Hey, thanks for all the replies!
    He is an 80 something that had fallen at home and laid on the floor for several hours before being found.
    And yes, his urine was very dark.
    Getting ready to head to work again tonight. Thank you all for giving me a better understanding of my patient!
    Esme12 likes this.
  11. Visit  Scarlette Wings profile page
    0
    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
  12. Visit  julz68 profile page
    2
    Quote from SkyeHawk3
    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
    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.
    FecesOccurs and Esme12 like this.
  13. Visit  DeLanaHarvickWannabe profile page
    2
    Quote from julz68
    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.
    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?
    me1989 and elprup like this.
  14. Visit  julz68 profile page
    0
    Quote from DeLanaHarvickWannabe

    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*


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