The importance of creatinine kinase level in discharge decision of patients with rhabdomyolysis

Yıl 2013, Cilt: 5 Sayı: 2, 26 - 30, 01.08.2013

Aysun Yakut Kadir Kayataş Refik Demirtunç Gülbüz Sezgin

Öz

A twenty-two years old men was admitted to emergency department after a motor vehicle accident, his physical examination revealed extended ecchimosis with creatinine kinase CK 37281 U/L value. The patient was refered to internal medicine clinic with the prediagnosis of rhabdomyolysis. In order to prevent rhabdomyolysis complications such as hyperkalemia, metabolic acidosis and acute tubular necrosis, hydration with 0.9% NaCI solution was administered. Serum CK was 6479 U/L at third day. Since CK was observed in the decreasing trend, the patient was recommended to drink liquids about 4000 ml/day and to check CK level every other day. In patients with possible rhabdomylolisis, CK, creatinine and K levels should be determined regardless of the muscular destruction extent and, in case of high levels, taking prompt measures to prevent complications seems wise.

Anahtar Kelimeler

rhabdomyolizis, creatine kinase, prosecution

Rabdomiyoliz ile takip edilen hastaların taburculuk kararında kreatinin kinaz düzeyinin önemi: Olgu sunumu

Öz

Araç içi trafik kazası nedeniyle acil servise getirilen 22 yaşında erkek hastanın, fizik muayenesinde; sağ frontalde ve sağ el bileğinde ekimozları olup laboratuvar incelemesinde kreatinin fosfokinaz CK seviyesi yüksekti. Hasta rabdomiyoliz ön tanısı ile iç hastalıkları servisine interne edildi. Hastada gelişebilecek hiperkalemi, metabolik asidoz ve akut tubuler nekroz gibi rabdomiyoliz komplikasyonlarının engellenmesi amacıyla %0.9`luk NaCl izotonik ile hidrate edildi. Yatışının üçüncü gününde serum CK`nın düşüş eğiliminde olduğu gözlenmesi üzerine hastaya 4000 ml/gün oral sıvı almasını ve günaşırı CK kontrolünün tarafımızca yapılması önerilerek hasta taburcu edildi. Post-travmatik rabdomiyoliz düşünülen hastalarda etkilenen kas hasarının miktarını göstermede ve takiplerde kullandığımız kreatin kinaz taburculuk planınında major belirteç olmadığı bu vakada düşünüldü. Rabdomiyoliz nedeniyle acil servise başvuran hastalarda etkilenen kas kitlesine bakılmaksızın serum CK, Cr, ve K değerleri incelenmeli, yüksek bulunan olgularda oluşabilecek komplikasyonların önlenmesi için tedaviye erken başlanmalıdır.

Anahtar Kelimeler

rabdomiyoliz, kreatin kinaz, taburculuk, takip

Kaynakça

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