From the Research
Patients with rhabdomyolysis should be admitted to the hospital when they have severe muscle breakdown with complications or high risk factors, as indicated by a peak creatine kinase level of at least 5000 U/L, which is 55% specific and 83% sensitive for the prediction of acute kidney injury requiring renal replacement therapy 1.
Indications for Hospital Admission
The following are indications for hospital admission in patients with rhabdomyolysis:
- Serum creatine kinase (CK) levels greater than 5,000-10,000 U/L, especially if rising rapidly
- Evidence of acute kidney injury (elevated creatinine, decreased urine output)
- Electrolyte abnormalities (particularly hyperkalemia, hyperphosphatemia, or hypocalcemia)
- Significant volume depletion requiring IV fluid resuscitation
- Metabolic acidosis
- Compartment syndrome
- Underlying conditions that increase risk (such as sepsis, severe trauma, or heat stroke)
Hospital Management
Initial hospital management includes:
- Aggressive IV fluid administration, typically isotonic saline at 1-2 L/hour initially, then adjusted to maintain urine output of 200-300 mL/hour until CK levels decrease
- Urinary alkalinization with sodium bicarbonate (to maintain urine pH > 6.5) may be considered in severe cases, though its benefit remains controversial 2, 3, 4
- Continuous cardiac monitoring when electrolyte disturbances are present
- Early intervention for complications
Outpatient Management
Milder cases with CK < 5,000 U/L, normal renal function, and no complications can often be managed as outpatients with:
- Oral hydration
- Close follow-up
- Laboratory monitoring It is essential to note that the management of rhabdomyolysis should be individualized, and the decision to admit a patient to the hospital should be based on the severity of the condition and the presence of complications or high-risk factors 5, 4.