Rhabdomyolysis is a rare clinical entity in a pediatric patient. There are very few documentated case reports of myoglobinuria. They usually present with muscle swelling, tenderness and firm consistency of calves and lower back with red urine. It is diagnosed by presence of myoglobin in urine and elevated S. Creatine Kinase. Its main complications are (a) Hypovolemia and shock due to influx of fluid into damaged muscles. (b) Electrolyte disturbances – hyperkalemia, hyperphosphatemia and hyperuricemia with metastatic calcifications. (c) Acute renal failure – Associated factors with development of renal failure are a peak S. CPK>16,000 IU/L, urine pH < 5 and arterial pH<7.33(3) (d) Compartment syndrome.

Management of myoglobinuria involves treatment of any reversible cause of myoglobinuria, aggressive volume resuscitation (as high as 250 – 300 ml/kg in 1st few hours), treatment of hyperkalemia with exchange resins, and treatment of ARF. Aim is to achieve a urine of flow more than 2ml/kg/hr with fluids and mannitol and Bicarbonate infusion to maintain urine pH>6. Dialysis may be required in 50-70% of patients.

Some children may present with headache and visual problems, which may be in long standing hypothyroidism due to hyperplastic enlargement of pituitary gland as a result of thyrotroph hyperplasia.

This case presented with classical red urine and elevated S.CPK and tender palpable calf muscles with severe shock and no other cause of fluid loss.Patient was managed aggressively and patient had a neurologically good outcome.

Thus,myoglobinuria requires a very early aggressive management of etiological agent and its complications.It should be suspected in any case of severe unexplained shock ,viral infections and crush injuries.S.CPK is a good screening test . In any patient if cause of myoglobinuria is not known then muscle biopsy and specific enzyme assays should be done if facilities are available to detect the cause of Idiopathic myoglobinuria.