From the Research
Initial management of rhabdomyolysis should focus on aggressive intravenous fluid resuscitation with isotonic crystalloids, such as normal saline, at rates of 200-300 mL/hour to maintain urine output of 200-300 mL/hour, as this helps dilute nephrotoxic myoglobin and prevents acute kidney injury, as supported by the most recent study 1.
Key Components of Initial Management
- Aggressive intravenous fluid resuscitation with isotonic crystalloids (normal saline) at rates of 200-300 mL/hour to maintain urine output of 200-300 mL/hour, which is crucial for preventing acute kidney injury and supported by studies such as 2 and 1.
- Monitoring of urine output hourly and adjusting fluid rates accordingly to ensure adequate hydration and prevent complications.
- Correction of electrolyte abnormalities, particularly hyperkalemia, which may require calcium gluconate, insulin with glucose, or sodium bicarbonate for severe cases, as highlighted in 3 and 4.
- Consideration of urinary alkalinization with sodium bicarbonate to maintain urine pH > 6.5, although its effectiveness remains controversial, as discussed in 5.
- Continuous cardiac monitoring due to the risk of electrolyte-related arrhythmias.
- Measurement of creatine kinase levels every 12 hours until declining, and checking renal function and electrolytes at least twice daily to monitor disease progression and response to treatment.
- Identification and treatment of the underlying cause of rhabdomyolysis, which is essential for preventing further muscle damage and improving outcomes, as emphasized in 2 and 4.
- Nephrology consultation if kidney function deteriorates despite initial management, as dialysis may be necessary for severe cases with refractory hyperkalemia or acidosis, as noted in 3 and 1.