What is the treatment for Rhabdomyolysis?

Treatment of Rhabdomyolysis

The cornerstone of rhabdomyolysis treatment is aggressive intravenous fluid resuscitation with isotonic saline (0.9% NaCl) targeting a urine output of >300 mL/hour to prevent acute kidney injury. 1

Immediate Management

1. Fluid Resuscitation

   • Begin with isotonic saline (0.9% NaCl) immediately
   • Avoid potassium-containing fluids like Lactated Ringer's as they may worsen hyperkalemia 1
   • Target urine output >300 mL/hour 1, 2
   • Continue aggressive hydration until creatine kinase (CK) levels decrease to <1,000 U/L 2

2. Electrolyte Management

   • Monitor and correct hyperkalemia urgently if present (life-threatening complication) 1
   • Address hypocalcemia if symptomatic 1
   • Monitor calcium, phosphorus, and magnesium levels regularly 1

3. Medication Management

   • Discontinue any causative agents immediately 1
   • If statin-induced, stop the statin immediately 1
   • Avoid all nephrotoxic medications including NSAIDs, ACE inhibitors/ARBs, and certain antibiotics 3, 1

Monitoring and Serial Evaluation

• Check CK levels every 6-12 hours in the acute phase 1
• Monitor electrolytes, renal function, and urine output frequently 1
• Assess for metabolic acidosis with arterial blood gas 1
• Watch for signs of compartment syndrome (pain, tension, paresthesia, paresis) 1

Complications Management

1. Acute Kidney Injury

   • Obtain nephrology consultation for all cases with acute kidney injury 1
   • Consider renal replacement therapy based on individual case severity 4

2. Compartment Syndrome

   • Measure compartment pressure if suspected (threshold >30 mmHg) 1
   • Perform decompressive fasciotomy if confirmed 1

3. Disseminated Intravascular Coagulation

   • Monitor coagulation studies (PT/PTT/INR) in severe cases 1

Controversial Therapies

• Sodium bicarbonate: May be considered for patients with acidosis, but evidence for routine use is limited 2
• Mannitol: Can be used if urine output goals are not met despite adequate fluid resuscitation, but evidence for improved outcomes is weak 4, 2
• Loop diuretics: Limited evidence for improved outcomes 4

Follow-up Care

• Follow up with primary care and/or nephrology within 1-2 weeks 1
• Maintain adequate hydration to prevent recurrence 1
• Consider genetic testing if recurrent episodes, exercise intolerance, or positive family history for neuromuscular disorders 1, 5

Common Pitfalls to Avoid

1. Delaying fluid resuscitation while waiting for laboratory confirmation 1
2. Using potassium-containing fluids for resuscitation 1
3. Failing to discontinue nephrotoxic medications 3, 1
4. Missing compartment syndrome diagnosis 1
5. Inadequate monitoring of electrolytes, especially potassium 1

Remember that early, aggressive fluid resuscitation is the most critical intervention in rhabdomyolysis management and has reduced mortality from nearly 100% to <20% in severe cases 6.