Question

A large bookcase falls upon an elderly man in his home. His left leg is pinned and he cannot move for 2 days until his neighbor finds him. He is hospitalized with massive trauma to his left leg, with resultant rhabdomyolysis (rhabdomyo means striated muscle tissue; lysis means "break down"). His pulses in that foot are unpalpable and the foot is pale and cool. Eventually his foot must be amputated.

Because of massive cellular injury, myoglobin leaks from cells into blood. The patient eventually develops kidney failure from this myoglobinemia. All the following are true about this situation EXCEPT

a. the patient may ultimately need injections of erythropoietin because of the ailing kidneys' failure to adequately create it.
b. myoglobinuria will likely be present acutely due to "spillage" of excess of myoglobin into the urine.
c. erythropoietin will be dangerously high in the blood secondary to kidney over-secretion of this hormone.
d. the etiology of the eventual kidney failure is most likely the high amounts of myoglobin that overwhelm the kidneys' ability to process it.

Answer 1

The patient is experiencing kidney failure due to rhabdomyolysis, resulting in the presence of myoglobin in the urine. Erythropoietin levels in the blood will not be dangerously high, but the patient may need injections of erythropoietin.

Step-by-step explanation:

The patient in this scenario is experiencing kidney failure due to rhabdomyolysis, which is the breakdown of muscle tissue resulting in the release of myoglobin into the blood. The high amounts of myoglobin overwhelm the kidneys' ability to process it, leading to kidney failure. Myoglobinuria, the presence of myoglobin in the urine, will likely be present acutely due to the excess spillage of myoglobin into the urine. However, erythropoietin levels in the blood will not be dangerously high in this situation; instead, the patient may ultimately need injections of erythropoietin because the kidneys are unable to adequately create it.