From the Research
Rhabdomyolysis with fever in children requires immediate medical attention and hospitalization, with initial management including aggressive intravenous fluid resuscitation and monitoring of electrolyte abnormalities, as outlined in the most recent study 1. The causes of rhabdomyolysis in pediatric patients are extensive, with viruses being the most common cause, as noted in a 2020 study 2. The management of pediatric rhabdomyolysis involves a general approach to history taking, physical examination, diagnosis, acute management, follow-up, and prevention. Some key points to consider in the management of rhabdomyolysis with fever in children include:
- Aggressive intravenous fluid resuscitation with normal saline at 10-20 mL/kg/hour to maintain urine output of 1-2 mL/kg/hour, with the goal of preventing acute kidney injury
- Monitoring of electrolyte abnormalities, particularly hyperkalemia, hypocalcemia, and hyperphosphatemia, and correcting them as necessary
- Identification and treatment of the underlying cause of fever, with common etiologies including viral infections, bacterial infections, heat stroke, or certain medications
- Laboratory monitoring, including creatine kinase (CK) levels, renal function tests, electrolytes, and urinalysis for myoglobinuria
- Consideration of allopurinol to prevent uric acid nephropathy, and sodium bicarbonate administration to maintain urine pH > 6.5, although the latter remains controversial 1
- Pain management with acetaminophen, which is preferred over NSAIDs, which may further stress the kidneys
- Close monitoring of compartment syndrome, as surgical fasciotomy may be required in severe cases It is essential to note that the combination of rhabdomyolysis and fever in children can indicate serious conditions such as viral myositis, autoimmune disorders, or metabolic myopathies, and therefore, prompt recognition and treatment are crucial to prevent potential complications, such as acute kidney injury, as highlighted in a 2020 study 2.