Rhabdomyolysis laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Laboratory Findings

  • Urinalysis
    • Blood (+)
    • No red blood cells on microscopy. This situation is either hemoglobin in the urine or myoglobin. The serum will be pink with hemoglobinuria.
  • Serum Markers
    • Elevated serum creatinine kinase
      • CK elevation: Generally accepted > 5 times normal. Corresponds to about 200g of muscle.
      • Begins to rise 2-12 hrs after onset. Peaks 1-3 days in. Declines 3-5 days after the process stops.
    • Myoglobin
      • Myoglobin: Starts earlier than CK but clears faster, so serum and urine myoglobin useful early in course of the disease. Myoglobin is eventually urinated and/or converted to bilirubin.
      • All myoglobinuria is caused by rhabdomyolysis, but not all rhabdomyolysis causes myoglobinuria. Urine changes color when > 1mg/ml.
    • LDH (lactic dehydrogenase)

Approach to the Evaluation of Rhabdomyolysis

  • Minimum Evaluation
    • Etiology certain:
      • CBC (complete blood count)
      • CK
      • Chemistries
      • Liver function tests
      • Urine pH
    • Consider looking for hypothyroidism and sickle cell trait.
  • Extensive Evaluation:

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