. 73 Male . Admitted with Unwitnessed Fall Unwitnessed Fall at Home. S

. 73 Male . Admitted with Unwitnessed Fall (Unwitnessed Fall at Home. Slipped on some polish on the floor.) on 09/09, stepped down to SHH on 12/09 BHH issues: 1. Rt NOF: Rt DHS on 10/9 SHH Issues: 1. Stepped Down 2. raised ck on routine bloods: statin paused and IVF given ck was 400 now 500, statin 80mg paused and iv fluids given, when is the best time to restart statin and what to write to gp, this is UK protocol, write in short and give the source as well

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UK Specialist Pharmacy Service statins monitoring creatine kinase raised CK stop restart statin rhabdomyolysis

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statin associated muscle symptoms AND management

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https://sps.nhs.uk/monitorings/statins-monitoring

CK 400 to 500 IU/L after an unwitnessed fall and hip surgery is likely multifactorial, but atorvastatin 80 mg should remain withheld while CK is rising. Check for muscle pain/weakness, dark urine, AKI and interacting medicines, and repeat CK plus U&Es/eGFR after hydration and clinical recovery.

Restart: If repeat CK is <5 times the laboratory ULN, renal function is stable and there are no ongoing muscle symptoms, restart at a lower intensity rather than atorvastatin 80 mg. For example, atorvastatin 20-40 mg nocte, with lipid-lowering indication and cardiovascular risk reviewed. If CK remains >5 times ULN, do not restart and seek lipid/specialist advice. SPS recommends re-measuring after 7 days and restarting at a lower dose only once CK is <5 x ULN. The fall itself is a recognised non-statin cause of CK elevation, so interpret the level in context.

Suggested GP discharge wording

Atorvastatin 80 mg nocte has been withheld due to rising CK (400 to 500 IU/L) following fall/hip fracture surgery. Patient received IV fluids; please repeat CK and U&Es/eGFR in approximately 7 days, once clinically recovered and well hydrated. If CK is <5 x local ULN, renal function stable and no myalgia, weakness or dark urine, please restart statin at lower dose (for example atorvastatin 20-40 mg nocte), titrating according to cardiovascular indication and tolerance. If CK remains >5 x ULN or muscle symptoms/renal impairment occur, do not restart and seek specialist/lipid-clinic advice.

Use the local laboratory ULN, because a CK of 500 IU/L is often below 5 x ULN but needs contextual assessment. The NHS SPS statin monitoring guidance states to stop statin if CK is >5 x ULN, repeat in 7 days, and restart at lower dose if it falls below 5 x ULN.

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