Page 111 - Journal of Special Operations Medicine - Summer 2015

confirm your plan. They agree that this patient should 10. Young SE, Miller MA, Docherty M. Urine dipstick testing to
be sent to the hospital and ask to monitor this patient’s rule out rhabdomyolysis in patients with suspected heat in-
jury. Am J Emerg Med. 2009;27:875–877.
urinary output and to obtain a baseline ECG during 11. Fernandez WG, Hung O, Bruno GR, et al. Factors predictive
transport. A four-wheeler is made available to help of acute renal failure and need for hemodialysis among ED
transport the patient to the road, where transfer is then patients with rhabdomyolysis. Am J Emerg Med. 2005;23:17.
made to a ground vehicle and then to the hospital. You 12. Agarwal S, Agarwal V, Taneja A. Hypokalemia causing rhab-
accompany the patient. domyolysis resulting in life threatening hyperkalemia. Pediatr
Nephrol. 2006;21:289–291.
13. Better OS, Stein JH. Early management of shock and prophy-
At the hospital, urine microscopy confirms absence of laxis of acute renal failure in traumatic rhabdomyolysis. N
RBCs, and laboratory workup shows an elevated CK Engl J Med. 1990;322:825–829.
level of 10,000 U/L. This clinches your suspected diagno-
sis of rhabdomyolysis secondary to exertional extremes
and dehydration. The patient is admitted to hospital,
provided with aggressive fluid therapy, and continued Sgt Banting of the Canadian Forces, is a medical technician
to be monitored until CK laboratory values peak and with extensive SOF experience who is currently on the Cana-
begin to decrease 48 hours later. He subsequently is dis- dian Forces Physician Assistant course.
charged without complication.
Major Meriano is a practicing emergency physician. He has
served in various capacities with the Canadian Forces and Re-
Disclosures serves since 2003. Comment and suggestions can be sent to
sofclinicalcorner@gmail.com.
The authors have nothing to disclose.

Disclaimer
The views and medical opinion herein represent those of
the authors. They do not reflect the operation practice
or views of the Canadian Forces or other organizations.
The cases are provided to be educational and thought
provoking; at no time does the author suggest that the
tactical clinicians exceed the scope of their practice or
act against the direction of their medical protocols or
recommendations of their medical leadership.

References
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failure) and nephrotic syndrome. 2013. http://www.uptodate.
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and update. Emergency Medicine Reports. 10 September 2012.
http://www.ahcmedia.com/newsletters/1/issues/73835.
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myolysis: causes and rates of renal failure. Pediatrics. 2006;
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Soc Nephrol. 2000;11:1553–1561.
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8. Lappalainen H, Tiula E, Uotila L, et al. Elimination kinetics of
myoglobin and creatine kinase in rhabdomyolysis: implications
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9. Minnema BJ, Neligan PC, Quraishi NA, et al. A case of occult
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Rhabdomyolysis 101