From the Guidelines
The treatment for Rhabdomyolysis should focus on aggressive intravenous fluid administration, with volumes greater than 6L required in patients with severe rhabdomyolysis (CPK >15,000 IU/L) to prevent acute kidney injury and the need for renal replacement therapy, as suggested by a retrospective study in 2011 1. The goal of treatment is to prevent kidney damage and address the underlying cause of the condition. Patients typically receive isotonic fluids like normal saline at rates of 200-300 mL/hour initially, adjusted based on clinical response.
- The treatment approach includes:
- Aggressive fluid resuscitation to maintain urine output at 200-300 mL/hour until myoglobin clears from the urine
- Addressing the underlying cause, such as stopping medications that triggered the condition, treating infections, or managing trauma
- Monitoring and correcting electrolyte abnormalities, particularly hyperkalemia, hypocalcemia, and hyperphosphatemia
- Pain management with appropriate analgesics for patient comfort
- Monitoring creatine kinase (CK) levels to track recovery
- In severe cases, dialysis may be necessary to manage acute kidney injury or dangerously high potassium levels, as referenced in the French recommendations for acute kidney injury in the perioperative period and intensive care units 1.
- It is essential to note that the volume to be administered remains debated, but most retrospective studies report that patients who eventually developed acute kidney injury had a longer time to initiate volume resuscitation compared to those who did not 1.
From the Research
Treatment for Rhabdomyolysis
The treatment for Rhabdomyolysis involves addressing the underlying cause of the condition, as well as providing supportive care to manage the symptoms and prevent complications. The key components of treatment include:
- Aggressive intravenous hydration to maintain a urine output of at least 300 mL/hour 2, 3, 4, 5
- Discontinuation of any medications or substances that may be contributing to the condition 2, 5
- Monitoring of electrolyte levels and management of any abnormalities 2, 3, 4, 5
- Monitoring of renal function and management of any acute kidney injury (AKI) that may develop 2, 3, 4, 5
Use of Bicarbonate and Other Medications
The use of bicarbonate in the treatment of Rhabdomyolysis is not universally recommended, and some studies suggest that it may not be beneficial in preventing AKI or improving outcomes 6. The use of mannitol and loop diuretics is also not supported by strong evidence, and their use should be individualized based on the patient's specific needs 2, 3, 5.
Management of Complications
Complications of Rhabdomyolysis, such as compartment syndrome and disseminated intravascular coagulation, require prompt recognition and management. Decompressive fasciotomy may be necessary to manage compartment syndrome, and supportive care may be needed to manage other complications 2, 3, 4, 5.
Hospital Admission and Discharge
Most patients with Rhabdomyolysis require hospital admission for management, although some patients may be suitable for discharge if their condition is mild and they can be safely managed in the outpatient setting 2. The decision to admit or discharge a patient should be based on the severity of their condition and their individual needs.