A 42-year-old male construction worker is extricated from a collapsed building after being trapped under heavy rubble for 6 hours. He sustained severe crush injuries to both lower extremities. On presentation to the emergency department, he is alert and oriented with the following findings: Vitals: BP 92/58 mmHg, HR 118 bpm, RR 22/min Labs: - Serum creatinine: 5.1 mg/dL (baseline 1.0 mg/dL) - Potassium: 7.2 mEq/L - Calcium: 7.1 mg/dL - Phosphate: 8.9 mg/dL - CK: 45,000 IU/L - Urinalysis: 3+ blood, no RBCs on microscopy, muddy brown casts present Which of the following is the most likely diagnosis?
- A)Acute glomerulonephritis secondary to crush injury
- B)Rhabdomyolysis-induced acute kidney injuryGABARITO
- C)Disseminated intravascular coagulation with acute tubular necrosis
- D)Hemolytic uremic syndrome
- E)Acute interstitial nephritis from nephrotoxic medications
Explicação
Rhabdomyolysis-induced acute kidney injury is the most likely diagnosis. The clinical presentation is classic: crush injury with prolonged entrapment, severe hyperkalemia (from muscle breakdown), hypocalcemia (from hyperphosphatemia and precipitation of calciu... Ver explicação completa e trilha adaptativa →