What are the guidelines for the treatment of rhabdomyolysis (muscle breakdown disease)?

From the Guidelines

The treatment of rhabdomyolysis should focus on aggressive intravenous fluid resuscitation with normal saline at rates of 1-2 L/hour, adjusted based on clinical response, to maintain urine output at 200-300 mL/hour until myoglobinuria clears, as recommended by recent guidelines 1.

Key Components of Treatment

• Aggressive fluid resuscitation with normal saline to maintain urine output and prevent myoglobin precipitation in renal tubules
• Bicarbonate therapy may be considered when urine pH is below 6.5, although its benefit remains controversial 1
• Mannitol can be administered to promote osmotic diuresis if urine output remains inadequate, but should be used cautiously in patients with renal failure 1
• Close monitoring and correction of electrolyte abnormalities, particularly hyperkalemia, hypocalcemia, and hyperphosphatemia
• Identification and addressing of the underlying cause of rhabdomyolysis, whether it's medication discontinuation, infection treatment, or correction of metabolic abnormalities

Additional Considerations

• Pain management with appropriate analgesics, avoiding nephrotoxic medications like NSAIDs
• Early physical therapy to prevent muscle atrophy and contractures
• Dialysis should be considered for patients with severe acute kidney injury, refractory hyperkalemia, or severe acidosis

Nutritional Support

• Total energy intake of 20-30 kcal/kg/d in patients with any stage of AKI, with administration of 0.8-1.0 g/kg/d of protein in noncatabolic patients with AKI without need for dialysis 1
• Patients with AKI on RRT require additional protein compared with patients with AKI who are not on RRT, up to a maximum of 1.7 g/kg/d in patients on continuous RRT (CRRT) and in hypercatabolic patients 1
• Enteral nutrition is preferred over parenteral nutrition in patients with AKI, as it is associated with a lower rate of complications 1

From the Research

Treatment Guidelines for Rhabdomyolysis

The treatment of rhabdomyolysis involves several key components, including:

• Aggressive intravenous fluid resuscitation (IVFR) to restore renal perfusion and increase urine flow, as recommended by 2, 3, 4, 5, 6
• Discontinuation of further skeletal muscle damage
• Prevention of acute renal failure
• Rapid identification of potentially life-threatening complications, such as hyperkalemia and compartment syndrome

Use of Bicarbonate, Mannitol, and Loop Diuretics

The use of bicarbonate, mannitol, and loop diuretics in the treatment of rhabdomyolysis is not universally recommended, with some studies suggesting that they may not improve outcomes, as noted by 2, 3, 4, 6

• Bicarbonate administration has not been shown to improve the incidence of acute renal failure and need for dialysis in patients with rhabdomyolysis, according to 2
• Mannitol administration has also not been shown to improve outcomes in patients with rhabdomyolysis, as reported by 2
• Loop diuretics may be used in some cases, but their use should be carefully evaluated to avoid hypovolemia, as cautioned by 5

Renal Replacement Therapy

Renal replacement therapy may be necessary in some cases of rhabdomyolysis, particularly in patients with severe acute kidney injury or electrolyte disturbances, as mentioned by 4, 5

• The decision to initiate renal replacement therapy should be made on a case-by-case basis, taking into account the individual patient's condition and needs

Importance of Early Diagnosis and Treatment

Early diagnosis and treatment of rhabdomyolysis are critical to preventing complications and improving patient outcomes, as emphasized by 2, 3, 4, 5, 6

• Delayed treatment can lead to increased morbidity and mortality, highlighting the need for prompt recognition and intervention in patients with rhabdomyolysis.