From the Research
The treatment for rhabdomyolysis with hyponatremia should prioritize aggressive intravenous fluid resuscitation with normal saline, careful correction of hyponatremia, and addressing the underlying cause, as supported by the most recent and highest quality study 1.
Key Components of Treatment
- Aggressive intravenous fluid resuscitation with normal saline (0.9% NaCl) at rates of 200-1000 mL/hour, depending on severity, to maintain urine output above 200-300 mL/hour, as recommended by 1.
- Careful management of hyponatremia correction, avoiding rapid correction exceeding 8-10 mEq/L in 24 hours to prevent osmotic demyelination syndrome, as cautioned by 2.
- Sodium correction can be achieved with hypertonic saline (3% NaCl) in severe cases (Na <120 mEq/L with neurological symptoms), administered at 1-2 mL/kg/hour, as suggested by 3.
- Monitoring and correction of potassium, calcium, and phosphorus levels as needed, as emphasized by 4.
- Consideration of urinary alkalinization with sodium bicarbonate to prevent myoglobin precipitation in renal tubules in severe cases, although its effectiveness is debated in the literature 1.
- Renal replacement therapy (dialysis) is indicated for patients with severe hyperkalemia, acidosis, uremia, or fluid overload unresponsive to medical management, as indicated by 5.
Addressing the Underlying Cause
- Treating the underlying cause of rhabdomyolysis, such as discontinuing offending medications, treating infections, or managing trauma, is essential for complete recovery, as highlighted by 3 and 4.
Prioritizing Morbidity, Mortality, and Quality of Life
- The primary goal of treatment should be to minimize morbidity, mortality, and improve quality of life, which can be achieved by following the recommended treatment approach, as supported by the highest quality study 1.