What type of Intravenous (IV) fluids are used for rhabdomyolysis?

From the Guidelines

Normal saline (0.9% sodium chloride) is the preferred IV fluid for treating rhabdomyolysis. According to the study by 1, the initial management of crush injury, which can lead to rhabdomyolysis, involves infusing 3–6 l IV fluids (depending on clinical condition and response) with 0.9% saline.

Key Considerations

• The goal of fluid resuscitation is to maintain adequate urine output and prevent acute kidney injury.
• The total daily fluid volume often ranges from 6-12 liters depending on the severity of the condition and the patient's response, as seen in the algorithm for fluid resuscitation in crush victims of mass disasters 1.
• Aggressive hydration helps dilute myoglobin in the bloodstream and promotes its excretion through the kidneys, preventing tubular obstruction and acute kidney injury.

Monitoring and Adjustments

• Careful monitoring of electrolytes (particularly potassium, calcium, and phosphate), renal function, and fluid status is essential to prevent complications like volume overload or electrolyte abnormalities.
• Fluid therapy should be continued until clinical improvement is observed and creatine kinase levels decrease substantially.
• The use of sodium bicarbonate to alkalinize the urine and mannitol to promote osmotic diuresis is not universally recommended and should be considered on a case-by-case basis.

Clinical Decision Making

• The decision to use IV fluids in rhabdomyolysis should be based on the individual patient's clinical condition, response to treatment, and potential risks and benefits.
• The study by 1 provides a framework for fluid resuscitation in crush injury, which can be applied to the management of rhabdomyolysis in other contexts.

From the Research

Types of IV Fluids Used for Rhabdomyolysis

• Crystalloid solutions are commonly used for fluid replacement in rhabdomyolysis patients 2, 3, 4
• Aggressive intravenous fluid resuscitation (IVFR) with crystalloid solutions is recommended to prevent and treat acute kidney injury (AKI) due to rhabdomyolysis 2, 3, 4
• There is no established benefit of using mannitol or giving bicarbonate infusion in the treatment of rhabdomyolysis 2, 3
• Sodium bicarbonate may be used to alkalize the urine, but its effectiveness is still debated 4, 5
• The use of diuretics may be considered in some cases, but its effectiveness is not well established 4

Key Considerations

• Early and aggressive fluid replacement is crucial in preventing and treating AKI due to rhabdomyolysis 2, 3, 4
• Electrolyte imbalances must be treated with standard medical management 2
• The prognosis of rhabdomyolysis is excellent when treated early and aggressively 2, 4