Something has changed with Ellie. Review Card #25 and the information you gathered during night shift report, then use this puzzle to connect what you're seeing.
1. Ellie's urine is dark and tea colored. This is explained by damaged muscle cells releasing
into the bloodstream, which is then filtered by the kidneys.
Myoglobin is a muscle protein. When muscle tissue is damaged, myoglobin spills into circulation and is filtered by the kidneys, giving urine its characteristic tea or cola color (myoglobinuria).
2. Ellie's CK level is markedly elevated. This is the nurse's direct evidence of
because CK is normally concentrated inside muscle cells.
CK (creatine kinase) is an enzyme found in high concentrations inside muscle cells. It only enters the bloodstream in large amounts when the muscle cell membrane is damaged, so a markedly elevated CK confirms skeletal muscle breakdown.
3. As muscle cells break down, intracellular
is released into circulation, placing Ellie at risk for life-threatening cardiac dysrhythmias.
Muscle cells hold a high concentration of intracellular potassium. When those cells are damaged, potassium is released systemically, causing hyperkalemia and increasing the risk of dangerous dysrhythmias.
4. Circulating myoglobin can precipitate inside the kidneys, causing
and contributing to Ellie's rising BUN and creatinine, a sign of acute kidney injury.
Myoglobin is toxic to the kidneys. It can precipitate within the renal tubules, especially when the patient is dehydrated, obstructing flow and contributing to acute tubular injury, which is reflected in the rising BUN and creatinine.
5. Ellie's generalized muscle pain, tenderness, and weakness reflect direct
, the same process responsible for the elevated CK and myoglobin release.
The pain, tenderness, and weakness Ellie is reporting come from the same underlying event as the lab findings: muscle fiber injury, which releases both CK and myoglobin into the bloodstream.
6. Taking all of these findings together, the nurse recognizes this clinical picture as most consistent with
.
Tea colored urine from myoglobinuria, a markedly elevated CK, hyperkalemia, and a rising BUN/creatinine together point to rhabdomyolysis: muscle breakdown severe enough to spill its contents into the bloodstream and threaten the kidneys.
Great work connecting the findings. Click Continue to see what to do next.
Ellie's labs confirm rhabdomyolysis.
With muscle breakdown confirmed, the care team needs to move quickly to protect her kidneys. Take the next card to see what the provider orders.
