Rosenberg T, et al. Outcome of Benign Acute Childhood Myositis: The Experience of 2 Large Tertiary Care Pediatric Hospitals. Pediatr Emerg Care. 2016 Aug 20. [Epub ahead of print]
- Retrospective Review of 54 patients with benign acute childhood myositis.
- CPK at least 3 times normal with median of 1800 and peak of 8500.
- 75% males, all children under 16 years of age.
- 40 of the 54 were admitted for IV hydration; but no details relative to what drove the admission or mean CPK levels on admission.
- None of the 54 patients encountered renal failure.
- Take-home points:
- 1) good history: Patients unable to walk or walk on tiptoes with foot plantar flexion and some knee flexion so as not to stretch calf muscles
- 2) good exam: bilateral tenderness to calf palpation, moderate pain to calf when foot is dorsiflexed, patient walks on tip toes with knees slightly flexed
- 3) minimal labs: Renal function test, CPK, and urinalysis
- Urinalysis: if hemoglobin positive but without red blood cells, likely represents myoglobinuria
- BUN and creatinine- if evidence of acute renal failure, probable admission for IV hydration. If only some dehydration, can be discharged home.
- CPK–levels less than 3000 can be discharged home. Levels more than 16,000 have been associated with renal injury (but this data was extrapolated from other clinical situations with increased CPK)
- Final take-home: Minimal labs needed, minimal intervention required other than hydration and/or pain management, admission may depend on size of patient and ability to get around at home.
Reviewed by Sam Spizman MD