Module 10: Discussion

Module 10: Discussion

A 28-year-old male presents to the primary care office for evaluation of left calf pain, swelling, and redness. He reports that this started one day ago and worsened today. He ran a 27-mile marathon 2 days ago and traveled for 3 hours in a car today. He reports slight pain on walking and a swollen red calf. He took Ibuprofen 600 mg twice today without relief. Patient reports being an experienced runner, running 3-5 miles daily. He trained for the marathon for 4 months. Patient also reports a history of exercise induced asthma and uses albuterol sulfate HFA as needed.

On physical exam patient appears in good health T 99 P 68 R 18 BP 118/78 wt. 175 lb, height 72 in. BMI 23.1. Heart rate is regular without murmurs, rubs, or gallops. Lungs clear bilaterally. HEENT WNL.Strength lower extremities +5 and DTRs + 2.Left calf erythematous, edematous, warm and tender on palpation.Pulses 3+.

Two possible diagnoses were considered: deep vein thrombosis (DVT) and rhabdomyolysis.

Stat ultrasound of left leg to rule out DVT was ordered and read as normal

CBC WNL

Creatine Kinase (CK) 23,000 U/L (normal 24-170 U/L)

BUN and Creatinine WNL

A diagnosis of rhabdomyolysis was made.

1. Discuss the pathophysiology of acute renal failure in rhabdomyolysis.