Medicine, 4 log units above normal!

Highest CPK I have ever seen:

That is the first CPK over one million I have seen. I love how the CPK of 4,000 on day one, you know the CPK that is 20x the upper limit of normal, is not high enough to even be rendered on the graph. For the scientific-minded here is the same data on a log rhythmic scale:

We were able to successfully alkalinize the urine (EBM purists can bite me, I  believe the bench data here) and she never became oliguric, however on day three her potassium was 7 and we initiated dialysis. Surprisingly, phosphorous never got out of control.

She also had the highest CRP I have ever seen, 147.

The etiology you ask? She presented three days after a sore throat. We initially discounted viral rhabdo because the CPKs were so high but the Coxsackie B type 3 and 4 antibodies were off the scale and the literature is sprinkled with similar case reports (here and here). Muscle biopsy results are pending.

Muddy brown cast (day one, unspun specimen):

Urine sample (day two with urine pH of 8.5), no red cell on U/A

Still can't believe I didn't get a picture of the urine on the first day, it was black.

.@kidney_boy re:CPK I see Phos was never uncontrolled - anything to say about Ca both at presentation & during alkalinisation? #nephrology
— Tom Oates (@toates_19) June 4, 2013

See this: