From the Research
No, D5 (dextrose 5%) is not an appropriate initial fluid for treating rhabdomyolysis. The recommended initial fluid for rhabdomyolysis treatment is isotonic saline (0.9% sodium chloride) administered at rates of 1-2 L/hour initially, followed by 300-500 mL/hour to maintain a urine output of 200-300 mL/hour. This aggressive fluid resuscitation should continue until serum creatine kinase (CK) levels decrease to below 1,000 U/L, as suggested by 1. D5 is contraindicated because it is hypotonic and contains glucose, which can worsen outcomes in rhabdomyolysis. The glucose may lead to osmotic diuresis and potentially exacerbate hyperkalemia, while the hypotonic nature fails to provide adequate volume expansion needed to flush myoglobin from the kidneys. Additionally, isotonic saline helps correct the metabolic acidosis often present in rhabdomyolysis and promotes renal blood flow, reducing the risk of acute kidney injury from myoglobin precipitation in renal tubules. Some key points to consider in the management of rhabdomyolysis include:
- Aggressive intravenous fluid resuscitation (IVFR) is conditionally recommended to improve outcomes of acute renal failure (ARF) and lessen the need for dialysis, as stated in 2.
- The use of bicarbonate or mannitol is not supported by high-quality evidence and is conditionally recommended against in patients with rhabdomyolysis, according to 2.
- Vigorous hydration with isotonic saline is a crucial component of rhabdomyolysis treatment, as noted in 3. In some cases, sodium bicarbonate may be added to alkalinize the urine (target pH >6.5), further preventing myoglobin precipitation and kidney damage. It is essential to prioritize the management of rhabdomyolysis based on the most recent and highest-quality evidence, which emphasizes the importance of aggressive fluid resuscitation with isotonic saline, as highlighted in 2.