What is the treatment for Rhabdomyolysis (muscle breakdown disease)?

Treatment of Rhabdomyolysis

Aggressive fluid resuscitation with isotonic saline (0.9% NaCl) targeting a urine output of >300 mL/hour is the cornerstone of rhabdomyolysis treatment to prevent acute kidney injury. 1, 2

Immediate Management

Fluid Resuscitation

• Begin immediate IV fluid therapy with 0.9% NaCl (isotonic saline) 1
• Target urine output of >300 mL/hour 1, 2, 3
• Do not delay fluid resuscitation while waiting for laboratory results 1
• Avoid potassium-containing fluids such as Lactated Ringer's solution 1

Electrolyte Management

• Monitor and urgently correct hyperkalemia if present 1
• Address hypocalcemia only if symptomatic 1
• Watch for and correct hyperphosphatemia 1

Diagnostic Approach

Laboratory Testing

• Serum creatine kinase (CK): Diagnostic threshold is typically ≥10 times the upper limit of normal 1
• Monitor CK levels every 6-12 hours during acute phase 1
• Essential tests include:
  • Plasma myoglobin (rises earlier than CK but has shorter half-life of 2-3 hours) 1
  • Serum electrolytes and renal function tests 1
  • Urinalysis (look for tea/cola-colored urine, positive for blood on dipstick but negative for RBCs on microscopy) 1
  • Consider coagulation studies if disseminated intravascular coagulation is suspected 1

Complications Management

Acute Kidney Injury

• Obtain nephrology consultation for all cases with acute kidney injury 1
• Consider renal replacement therapy for:
  • Severe hyperkalemia
  • Acidosis
  • Volume overload
  • Uremic symptoms 1
• Discontinue all nephrotoxic medications (NSAIDs, ACE inhibitors/ARBs, certain antibiotics) 1

Compartment Syndrome

• Monitor for signs of compartment syndrome: pain, tension, paresthesia, and paresis 1
• Measure compartment pressure if suspected (threshold >30 mmHg or differential pressure <30 mmHg) 1
• Obtain urgent surgical consultation for fasciotomy if compartment syndrome is confirmed 1

Ongoing Management

Medication Considerations

• Discontinue any causative agents (e.g., statins) immediately 1
• Evaluate for statin-associated autoimmune myopathy if symptoms persist after statin discontinuation 1

Follow-up Care

• Schedule follow-up with primary care and/or nephrology within 1-2 weeks 1
• Continue IV fluids until CK levels decrease to <1,000 U/L 3
• Educate patients to recognize early symptoms of recurrence 1

Special Considerations

Genetic Evaluation

• Obtain detailed three-generation family history if recurrent episodes or suspected genetic cause 1
• Consider genetic counseling and family screening when hereditary disorder is identified 1
• Consider specific gene panels for:
  • Glycogen storage diseases
  • Fatty acid oxidation disorders
  • Mitochondrial disorders
  • Muscular dystrophies
  • Ion channelopathies 1

Common Pitfalls to Avoid

1. Delaying fluid resuscitation while waiting for laboratory confirmation
2. Using potassium-containing fluids for resuscitation
3. Failing to monitor for compartment syndrome
4. Continuing nephrotoxic medications
5. Inadequate fluid resuscitation (target urine output must be >300 mL/hour)

While some sources have mentioned sodium bicarbonate and mannitol as potential treatments 3, 4, the most recent evidence does not strongly support their routine use 2. The primary focus should remain on aggressive fluid resuscitation with isotonic saline to prevent acute kidney injury.