From the Research
The treatment for rhabdomyolysis in pediatric patients primarily focuses on aggressive intravenous fluid administration to prevent kidney injury, as recommended by the most recent and highest quality study 1. The initial management includes isotonic fluids, typically normal saline, at 10-20 mL/kg bolus followed by maintenance fluids at 1.5-2 times the daily requirement to maintain urine output of 1-2 mL/kg/hour.
- Fluid therapy should continue until creatine kinase (CK) levels decrease significantly, typically below 5,000 U/L.
- Urine alkalinization with sodium bicarbonate may be considered in severe cases, though its benefit remains controversial, as noted in 1.
- Electrolyte imbalances, particularly hyperkalemia, hypocalcemia, and hyperphosphatemia, should be monitored and corrected as needed.
- Dialysis may be necessary for patients with severe acute kidney injury, persistent hyperkalemia, or significant fluid overload unresponsive to diuretics.
- Pain management with appropriate analgesics is important, avoiding nephrotoxic medications like NSAIDs.
- The underlying cause of rhabdomyolysis should be identified and treated specifically, as seen in cases like severe hypothyroidism presenting with rhabdomyolysis 2. Close monitoring of renal function, electrolytes, and CK levels is essential throughout treatment, with frequency determined by clinical severity, as emphasized in 3 and 4.