Pitfalls

Calcium levels can be high or low during the development of the condition – be wary of using calcium to treat hyperkalaemia
The increase in serum potassium appears to be most marked during the first 12-36 hours after muscle injury. Treat potassium levels with caution – remember the ECG changes are non-specific
Fluid status must be monitored closely as patients are easily under or overfilled
Early fluid resuscitation must be commenced as soon as possible and preferably pre-hospitally if possible
Do not delay renal replacement therapy if other measures fail to correct the metabolic disturbances
CK levels do not determine prognosis
Skeletal muscle is able to tolerate warm ischaemia for up to 2 hours – after this time damage is often irreversible