From the Research
Patients with rhabdomyolysis can be discharged when they demonstrate clinical stability, resolution of the precipitating cause, improving creatine kinase (CK) levels, normal renal function, and adequate urine output, as supported by the most recent study 1. The discharge criteria for rhabdomyolysis include:
- CK levels decreased to below 5,000 U/L or a consistent downward trend for 2-3 consecutive days
- Normalized serum creatinine or returned to baseline
- Corrected electrolyte abnormalities, particularly potassium, calcium, and phosphate
- Ability to maintain adequate oral hydration without intravenous fluids
- Normal urine output of at least 0.5-1 mL/kg/hour
- Freedom from complications such as compartment syndrome or severe metabolic derangements Prior to discharge, patients should receive clear instructions to:
- Maintain oral hydration of 2-3 liters daily for several days
- Avoid nephrotoxic medications and substances that triggered the rhabdomyolysis
- Schedule follow-up within 1-2 weeks for repeat CK and renal function testing The risk of acute kidney injury and other complications significantly decreases once CK levels trend downward and renal function stabilizes, indicating that the muscle breakdown process has been effectively controlled, as noted in 2 and 1. It is essential to consider the causes of rhabdomyolysis, including traumatic etiology, immobilization, sepsis, drugs, and alcohol, as well as the potential for exertional rhabdomyolysis, which may be more prevalent than previously thought, as highlighted in 1. The treatment of rhabdomyolysis is based on early and intensive fluid therapy to avoid kidney complications, as emphasized in 2 and 3. By prioritizing the most recent and highest-quality study 1, we can ensure that patients with rhabdomyolysis receive evidence-based care and are discharged when it is safe to do so, minimizing the risk of morbidity, mortality, and improving quality of life.