Unknown Problem Run

[Melclin]

+1 on the Rhabdo. I had a patient on the floor for only a couple hours who had a CK of 50K with pretty substantial AKI. With an underlying infection or disease process added to the equation you can get very sick very fast. Respiratory failure was probably due to exhaustion from being tachypneic for days.

Pretty much this. Pt is sick with one of any number of diseases, contributes to generalized weakness, dehydration from poor ability to care for self/resp rate/illness. Pt lays on floor for a while. Further dehyration, worsening illness, +/-rhabdo. The "mild heart attack" was interesting. Don't kidney failure pts have some minor troponin rise fairly routinely?

But there wasn't really a great deal to go on. Just a heads up for future cases, we'll need a little more detail and structure if you want a genuine attempt at us figuring it out.

 

[VFlutter]

The "mild heart attack" was interesting. Don't kidney failure pts have some minor troponin rise fairly routinely?

You will have minor troponin elevation with renal failure and pretty significant elevation with Rhabdo. In the presence of Rhabdo you can not really make a NSTEMI diagnosis based off enzymes alone so there may have been some EKG or Echo abnormalities. With all that was going on hypercoagation would not be suprising.

 

[EMT B]

what about the renal failure causes troponin release?

 

[Melclin]

You will have minor troponin elevation with renal failure and pretty significant elevation with Rhabdo. In the presence of Rhabdo you can not really make a NSTEMI diagnosis based off enzymes alone so there may have been some EKG or Echo abnormalities. With all that was going on hypercoagation would not be suprising.

Yeah, that was my understanding, but I'm certainly no expert.

Some ECG/echo changes? Around my way it seems more likely someone just saw a troponinrise and assumed nSTEMI. Wouldn't be the first time