Successful management of a patient with rhabdomyolysis and marked elevation of serum creatine kinase level

摘要

We experienced successful management of a patient with severe rhabdomyolysis by conservative treatment. A 41-year-old man developed Stanford-A-type acute aortic dissection and underwent an emergent replacement of the aortic root and arch. After the weaning from cardiopulmonary bypass, his left femoral artery was found non-pulsatile, probably due to extension of the aortic dissection, and femoro-femoral artery bypass surgery was added. Estimated ischemia time of the lower extremities was 7 hours. On admission to the intensive care unit (ICU), his left lower extremity showed signs of reperfusion injury accompanied with marked elevation of serum creatine kinase (12,397 IU x l(-1)) and myoglobin (19,980 ng x ml(-1)), and impaired oxygenation (a ratio of PaO2 to FIO2, 130 mmHg). We performed (1) moderately aggressive infusion treatment, (2) maintenance of hyperdynamic states using catecholamine, (3) diuresis therapy using atrial natriuretic peptide and furosemide, and (4) lung protective strategy. Although serum creatinine increased to 2.0 mg x dl(-1) on postoperative day (POD) 1, diuresis was maintained and the level of creatinine returned to normal on POD 6. He was extubated on POD 6 and discharged on POD 7. The early start of these combined therapies seems to have prevented acute renal failure without blood purification.