Clinical Pearl Wednesday #70

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Don’t forget about rhabdomyolysis with statin use!

Even though this is rare, it happens more often than you think!

The most common symptoms are myalgia, dark colored urine, and muscle weakness. But be aware! Sometimes, the patient might not be having any symptoms at all, which tends to be more common in the elderly, but not always…

I had a recent 46-year-old men’s health patient who I started atorvastatin on for hyperlipidemia. We tried EVERYTHING to get his numbers down, but nothing worked, therefore we started 10mg atorvastatin (lowest dose). I had him return in 4 weeks just to check his CPK and CMP (I have a friend who got hit with a bad malpractice case surrounding statins and rhabdomyolysis, therefore I am paranoid with them).  His LFTs were in the low hundreds and he had mild hyperkalemia and hyponatremia. Signs of potential mild rhabdo. Guess what? He was totally asymptomatic with normal CPK. I chalked it up to a lab error, and we rechecked his CMP and CPK 1 week later. His CPK was now mildly elevated and he still had elevated LFTs, hyperkalemia, and hyponatremia. I stopped the atorvastatin immediately and rechecked his labs a week later. Completely normal… Magic. He was having an adverse reaction to the atorvastatin which could have potentially led to a more serious issue, but thankfully it was caught early and only progressed to a mild case!

So, when you prescribe statins, have a watchful eye for rhabdomyolysis. Mild cases CAN happen, even without symptoms.

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