From the Guidelines
Patients with rhabdomyolysis can be discharged when their CK levels are trending downward, typically below 5,000 U/L, and they are clinically stable, adequately hydrated, and have normal renal function. The decision to discharge should be individualized based on the patient's overall clinical picture rather than a single CK value, as there is no universally accepted specific CK level threshold for discharging patients with rhabdomyolysis 1.
Key Considerations for Discharge
- Clinically stable
- Adequately hydrated
- Normal renal function
- Ability to maintain oral hydration
- No electrolyte abnormalities
Monitoring and Treatment
Intravenous fluid therapy with normal saline at 150-200 mL/hour should be continued until CK levels are declining and the patient can maintain adequate oral hydration. Monitoring of renal function, electrolytes (particularly potassium, calcium, and phosphate), and urine output is essential before discharge. The rate of CK decline is more important than the absolute value, with a typical decrease of about 40-50% per day expected in properly treated patients 1.
Post-Discharge Care
After discharge, patients should continue oral hydration of at least 2-3 liters daily and follow up within 1-2 weeks for repeat CK and renal function testing. Elevated CPK levels above 75,000 IU/L have been associated with a high incidence of newly formed acute kidney injury, highlighting the importance of close monitoring and follow-up 1.
From the Research
Discharge Criteria for Rhabdomyolysis
- The decision to discharge a patient with rhabdomyolysis is based on various factors, including the level of creatine kinase (CK) in the blood, the presence of acute kidney injury (AKI), and the patient's overall clinical condition 2.
- According to a study published in 2015, patients with exertional rhabdomyolysis were discharged when their CK levels downtrended, with a mean discharge CK of 23,865 U/L (range: 1,410-94,665 U/L) 2.
- Another study published in 2008 suggests that serum CK five times higher than the normal value usually confirms rhabdomyolysis, but it does not provide a specific CK level for discharge 3.
- It is essential to note that the CK level at which a patient can be discharged varies depending on the individual case and the presence of other complications, such as AKI 2.
Factors Influencing Discharge
- The length of stay in the hospital correlates significantly with peak CK levels, with higher peak CK levels predicting longer length of stay 2.
- The presence of AKI, which occurs in 33-50% of patients with rhabdomyolysis, is a significant factor in determining the discharge criteria 3.
- Electrolyte disturbances, such as hyperkalemia and hyperphosphatemia, should be carefully treated and monitored before discharge 4.
- The use of bicarbonate or diuretics may be helpful in some cases, but their indications should be well evaluated to avoid hypovolemia and other complications 4, 5.