A 42-year-old man with rhabdomyolysis from substance abuse and minor trauma.

During initial assessment and care of this patient, an element of disbelief of the patient's inability to move his extremities was expressed. Manifestation of a severe injury such as that affecting the spinal cord after an extended period of time would be unusual. All other causes of altered motor function should be promptly investigated. The importance of listening and believing the patient was reinforced with this case. Many excellent clinicians will state that 80% of the diagnosis comes from the patient history. The physical examination and diagnostic tests should only validate what has been obtained from listening to the patient. Although we had cared for patients with hyperkalemia in the past, this case expanded our knowledge about a range of therapies available to treat this electrolyte abnormality and the physiologic mechanisms for each. We are impressed with the number of mechanisms and medications that can contribute to the development of rhabdomyolysis. Caregivers are at risk of assuming that the patient's condition fits the category to which they have been triaged. Keeping an open mind concerning the range of rationale for patient signs and symptoms is important.