From the Guidelines
The treatment for rhabdomyolysis should focus on aggressive intravenous fluid administration, typically with normal saline at rates of 200-300 mL/hour initially, to restore fluid volume and prevent kidney damage by diluting myoglobin and promoting its excretion, as suggested by recent guidelines 1.
Key Components of Treatment
- Aggressive intravenous fluid administration with normal saline to restore fluid volume and prevent kidney damage
- Monitoring urine output, electrolytes, and kidney function to guide treatment
- Identification and addressing of the underlying cause of rhabdomyolysis
- Avoidance of nephrotoxic medications and adequate pain management
Fluid Administration
Patients should receive 3-6 liters of IV fluids daily until creatine kinase (CK) levels decrease significantly, with some studies suggesting that volumes greater than 6L may be required in patients with severe rhabdomyolysis (CPK >15,000 IU/L) to prevent acute kidney injury and the need for renal replacement therapy 1.
Monitoring and Management
- Monitoring urine output (targeting >200 mL/hour)
- Monitoring electrolytes (especially potassium, calcium, and phosphorus)
- Monitoring kidney function
- Severe hyperkalemia may require calcium gluconate, insulin with glucose, sodium bicarbonate, or potassium-binding resins
- Urinary alkalinization with sodium bicarbonate (to maintain urine pH >6.5) may be considered in severe cases to reduce myoglobin precipitation in kidney tubules
Renal Replacement Therapy
Renal replacement therapy (dialysis) is necessary for patients with severe acute kidney injury, persistent hyperkalemia, or significant acidosis, as indicated by recent studies 1.
Outcome
Recovery typically occurs within days to weeks, depending on severity, with most patients regaining normal kidney function if treated promptly, highlighting the importance of early and aggressive treatment 1.
From the Research
Treatment Overview
The treatment of rhabdomyolysis involves several key components, including:
- Aggressive intravenous fluid resuscitation (IVFR) to improve outcomes and reduce the need for dialysis 2, 3, 4, 5, 6
- Correction and prevention of electrolyte abnormalities, such as hyperkalemia 4, 5, 6
- Identification and management of potential complications, including acute renal failure, compartment syndrome, and cardiac dysrhythmias 2, 4, 5
Fluid Resuscitation
Aggressive IVFR is a crucial component of rhabdomyolysis treatment, with the goal of restoring renal perfusion and increasing urine flow 3, 5. The use of alkaline solutions, such as sodium bicarbonate, has been debated, but there is limited evidence to support its routine use 2, 5.
Adjunctive Therapies
Other adjunctive therapies, such as diuretic therapy and mannitol, have been used in the treatment of rhabdomyolysis, but their effectiveness is not well established 2, 4, 5. The lack of high-quality evidence to support these interventions highlights the need for further research in this area.
Complications and Management
Rhabdomyolysis can be complicated by several life-threatening conditions, including: