Treatment of Rhabdomyolysis
Aggressive fluid resuscitation with isotonic saline targeting urine output of 200-300 mL/hour (at least 6L daily for severe cases) is the cornerstone of rhabdomyolysis treatment to prevent acute kidney injury. 1
Initial Management
Fluid Resuscitation
- Begin immediate IV fluid therapy with isotonic saline (0.9% NaCl) 1, 2
- Target urine output: 200-300 mL/hour 1
- Daily fluid target: At least 6L for severe cases 1
- Continue aggressive hydration until CK levels decrease to <1,000 U/L 3
Monitoring
- Check serum electrolytes, renal function, and CK levels every 4-6 hours initially 1
- Monitor for:
Advanced Management
Electrolyte Management
- Add potassium (20-30 mEq/L) to IV fluids once renal function is assured 1
- Correct electrolyte imbalances promptly to prevent cardiac arrhythmias 3
Adjunctive Therapies
- Not recommended: Bicarbonate administration and mannitol have not been shown to improve outcomes 2
- Consider early nephrology consultation for significantly elevated CK levels 1
- Prepare for potential renal replacement therapy in severe cases 1
Compartment Syndrome Management
- Perform frequent neurovascular checks 1
- Measure compartment pressure if suspected (threshold >30 mmHg or differential pressure <30 mmHg) 1
- Obtain immediate surgical consultation if compartment syndrome is suspected 1
- Decompressive fasciotomy is required for definitive management 3
Special Considerations
High-Risk Patients
- Patients with heart failure: Balance treating dehydration while avoiding fluid overload 1
- Elderly patients: More careful fluid titration to prevent overload 1
- Patients with lower muscle mass or cardiac/renal compromise: Require closer monitoring 1
Automated Fluid Management
- Recent research suggests automated fluid management systems (like RenalGuard®) may achieve target urine output more effectively than manual management 4
- These systems resulted in higher urine output more quickly in rhabdomyolysis treatment 4
Potential Complications to Monitor
- Volume overload 1
- Worsening renal function 1
- Hyperkalemia or hypokalemia 1
- Compartment syndrome 1
- Acute kidney injury (most significant complication) 3
- Disseminated intravascular coagulation 3
Early and aggressive fluid resuscitation has reduced mortality from nearly 100% to <20% in severe rhabdomyolysis cases, particularly in crush syndrome 5. The key to successful management is prompt recognition and immediate implementation of aggressive fluid therapy to preserve renal function.