What is the duration of rhabdomyolysis and how long do inpatients require intravenous (IV) fluids?

From the Guidelines

The duration of rhabdomyolysis treatment with IV fluids typically ranges from 2-5 days but may extend to 1-2 weeks in severe cases, with the goal of maintaining adequate renal perfusion and promoting myoglobin clearance until creatine kinase (CK) levels show a consistent downward trend and kidney function stabilizes 1.

Key Considerations

• The severity of muscle damage and presence of complications like acute kidney injury play a crucial role in determining the treatment duration and intensity of IV fluid administration.
• Initial fluid administration should be aggressive, with rates of 1-2 L/hour for the first few hours, followed by maintenance rates of 200-300 mL/hour, adjusted based on urine output (targeting 200-300 mL/hour) 1.
• Normal saline is typically used, though some clinicians add sodium bicarbonate to alkalinize urine if the patient's pH is below 6.5.
• Monitoring parameters include CK levels, renal function tests, electrolytes (particularly potassium, calcium, and phosphate), and urine output.

Treatment Approach

• Patients with severe rhabdomyolysis (CPK >15,000 IU/L) may require volumes greater than 6L of IV fluids per day to prevent acute kidney injury and the need for renal replacement therapy, whereas 3–6L per day may be sufficient in moderate rhabdomyolysis 1.
• The management of kidney injury built up after rhabdomyolysis has no specificity, and experts refer to the French recommendations for acute kidney injury in the perioperative period and intensive care units 1.

Individualized Care

• Treatment duration is highly individualized and depends on the patient's overall clinical response to therapy, with the goal of preventing complications and promoting recovery.
• Close monitoring of patients is essential to adjust the treatment approach as needed and to prevent potential complications.

From the Research

Duration of Rhabdomyolysis

• The duration of rhabdomyolysis can vary depending on the severity of the condition and the effectiveness of treatment 2, 3, 4, 5, 6.
• Studies have shown that early and aggressive intravenous fluid resuscitation can help reduce the risk of acute kidney injury and improve outcomes in patients with rhabdomyolysis 3, 5, 6.

IV Fluid Administration

• The administration of IV fluids is a crucial aspect of treating rhabdomyolysis, with the goal of maintaining a urine output of at least 300 mL/h in adults 3, 5, 6.
• The duration of IV fluid administration can vary, but it is generally recommended to continue for at least 24 hours or until the patient's urine output is stable 6.
• Some studies have suggested that automated fluid management systems, such as the RenalGuard device, can help optimize urine output and reduce the risk of fluid accumulation in patients with rhabdomyolysis 2.

Treatment Guidelines

• The Eastern Association for the Surgery of Trauma recommends aggressive IV fluid resuscitation for patients with rhabdomyolysis, with the goal of improving outcomes and reducing the risk of acute kidney injury 3.
• The use of sodium bicarbonate and mannitol is not recommended unless necessary to correct systemic acidosis or maintain urine output, respectively 3, 6.
• Early initiation of IV fluids, preferably within the first 6 hours after muscle injury, is crucial for preventing acute kidney injury and improving outcomes in patients with rhabdomyolysis 6.