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.
