From the Guidelines
The primary treatment for rhabdomyolysis in the Emergency Department (ED) should focus on aggressive intravenous fluid resuscitation with normal saline, aiming to maintain urine output at 200-300 mL/hour, alongside monitoring and management of electrolyte abnormalities and urine pH, as recommended in the context of acute care for severe limb trauma patients 1.
Key Components of Treatment:
- Aggressive intravenous fluid resuscitation with normal saline at an initial rate of 1-2 L/hour, adjusted based on the patient's cardiovascular status and urine output.
- Monitoring of urine output and adjustment of fluid resuscitation to maintain output at 200-300 mL/hour.
- Electrolyte management, particularly correction of hyperkalemia, which may involve calcium gluconate, insulin, sodium bicarbonate, or potassium-binding resins.
- Maintenance of urine pH at 6.5 through appropriate management, as suggested by guidelines for acute care of severe limb trauma patients 1.
- Identification and treatment of the underlying cause of rhabdomyolysis.
Additional Considerations:
- Continuous cardiac monitoring due to the risk of electrolyte disturbances affecting cardiac function.
- Consideration for surgical consultation in cases of compartment syndrome.
- Admission to an intensive care unit for patients with significant kidney injury, severe electrolyte abnormalities, or those failing to improve with initial management, with potential need for renal replacement therapy if acute kidney injury progresses.
- The importance of repeated bio-assessment combining plasma myoglobin, plasma creatine phosphokinase (CPK), and kalaemia measurements to detect acute kidney injury, as well as bladder catheterization to monitor hourly urine output and urine pH 1.
From the Research
Treatment for Rhabdomyolysis in the ED
The treatment for rhabdomyolysis in the Emergency Department (ED) involves several key components:
- Early and aggressive fluid resuscitation to restore renal perfusion and increase urine flow 2, 3, 4, 5
- Discontinuation of further skeletal muscle damage 2
- Prevention of acute renal failure 2, 3, 4
- Rapid identification of potentially life-threatening complications such as hyperkalemia and compartment syndrome 2, 4
Fluid Resuscitation
Fluid resuscitation is a critical component of treatment for rhabdomyolysis:
- Isotonic saline solution should be infused at a rate of 1.5 liters per hour 6
- Alkaline solution with ≥12 l daily intravenous infusion can help stabilize the circulation and mobilize edema fluids 3
- Normal saline is the most commonly reported treatment for decreasing CK levels and myoglobinuria 5
- The addition of compounds such as sodium bicarbonate, sodium chloride, or potassium chloride to the IV fluid may be beneficial 5
Other Treatments
Other treatments for rhabdomyolysis may include:
- Preventive fasciotomy in cases of suspected compartment syndrome 6
- Renal replacement therapy for refractory hyperkalemia, acidosis, or volume overload 4
- Monitoring of electrolyte levels and renal function 2, 4
Important Considerations
It is essential to note that: