Outpatient Management of Rhabdomyolysis
The cornerstone of outpatient rhabdomyolysis treatment is aggressive oral fluid resuscitation with a goal of 3-6L per day for moderate cases, along with close monitoring of electrolytes and renal function. 1
Initial Assessment and Monitoring
- Evaluate for severity of rhabdomyolysis through laboratory testing including creatine kinase (CK), electrolytes (particularly potassium), renal function, and urinalysis for myoglobinuria 2, 1
- Classify severity based on CK levels: moderate cases typically have CK 5,000-15,000 IU/L, while severe cases have CK >15,000 IU/L 1, 3
- Monitor for signs of compartment syndrome including pain, tension, paresthesia, and paresis which are early warning signs requiring immediate medical attention 1
- Check for electrolyte abnormalities, particularly hyperkalemia, which can lead to life-threatening cardiac arrhythmias 1, 4
Treatment Protocol
Fluid Management
- Prescribe aggressive oral hydration with a minimum of 3-6L of fluid per day for moderate cases that can be managed as outpatients 1, 3
- Instruct patients to maintain clear, dilute urine output as a marker of adequate hydration 3, 4
- Consider intravenous fluid administration in an observation unit for patients with moderate dehydration or difficulty maintaining oral intake 3
Electrolyte Management
- Monitor and correct significant electrolyte abnormalities, particularly hyperkalemia, which requires urgent treatment 1, 4
- Schedule follow-up laboratory testing within 24-48 hours to assess electrolyte status and renal function 3
Medication Management
- Discontinue any potential causative medications, particularly statins if statin-induced rhabdomyolysis is suspected 2, 1
- Avoid nephrotoxic medications including NSAIDs and certain antibiotics that may worsen kidney injury 3, 4
Criteria for Hospital Admission
Patients with any of the following should be admitted rather than managed as outpatients:
- CK levels >15,000 IU/L 1, 3
- Significant electrolyte abnormalities, especially hyperkalemia 1, 4
- Evidence of acute kidney injury (elevated creatinine) 3, 4
- Signs of compartment syndrome 1
- Inability to maintain adequate oral hydration 3
- Significant comorbidities that increase risk of complications 4
Follow-up Care
- Schedule follow-up within 24-48 hours for laboratory reassessment 3
- Continue monitoring CK levels until trending downward and approaching normal range 1, 3
- Evaluate for underlying causes of rhabdomyolysis to prevent recurrence 5, 6
- Provide education on prevention strategies based on etiology (e.g., proper hydration during exercise for exertional rhabdomyolysis) 1
Special Considerations
- For exertional rhabdomyolysis, recommend gradual return to physical activity only after CK levels normalize and symptoms resolve 1, 3
- For medication-induced cases, document the causative agent and advise patients to avoid it in the future 2, 1
- Consider referral to specialists (nephrology, neurology) for patients with recurrent episodes or suspected underlying metabolic disorders 7
Warning Signs Requiring Immediate Medical Attention
Instruct patients to seek immediate medical care if they develop: