The Clinical Problem Solvers Episode 403: Schema Episode – Rhabdomyolysis
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Jun 24, 2025 An intriguing case of atraumatic rhabdomyolysis sets the stage for a discussion on a 41-year-old man with acute leg weakness linked to substance use. The speakers delve into the complexities of diagnosis, emphasizing neurological examinations and the interplay between mental health and physical symptoms. Initial lab results reveal critical indicators, underscoring the importance of monitoring creatine kinase levels. The episode highlights treatment strategies and the serious implications of rhabdomyolysis, enriching the conversation with personal anecdotes and clinical insights.
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Case Presentation of Acute Leg Weakness
- A 41-year-old man experienced acute bilateral leg weakness after smoking crack cocaine.
- Despite no sensory changes, he had significant lower extremity strength deficits with normal reflexes and sensation.
Reflexes Guide Neuro Localization
- Reflex examination can help localize neuromuscular issues: normal reflexes suggest muscle disease.
- The absence of sensory or perineal symptoms made cauda equina less likely in this case.
Lab Signature of Rhabdomyolysis
- Rhabdomyolysis causes pigment nephropathy and is diagnosed by creatine kinase elevation.
- Its lab signature resembles tumor lysis syndrome with elevated potassium, phosphate, uric acid, and lowered calcium.