What is the immediate treatment for Rhabdomyolysis?

Immediate Treatment for Rhabdomyolysis

The cornerstone of immediate treatment for rhabdomyolysis is aggressive intravenous fluid resuscitation with a goal urine output of 300 mL/hour to prevent acute kidney injury. 1, 2

Initial Management

• Begin aggressive IV fluid resuscitation immediately upon diagnosis:

  • For severe rhabdomyolysis (CK >15,000 IU/L): >6L of fluid per day 1, 2
  • For moderate cases: 3-6L of fluid per day 1, 2
  • Normal saline is the preferred initial fluid 3

• Monitor and correct electrolyte abnormalities, particularly:

  • Hyperkalemia (can lead to life-threatening cardiac arrhythmias) 1, 2
  • Hypocalcemia 4
  • Hyperphosphatemia 4

• Closely monitor renal function:

  • Regular assessment of BUN, creatinine 1
  • Monitor urine output to ensure adequate response to fluid therapy 3

Additional Interventions

• Consider urine alkalinization with sodium bicarbonate for patients who are acidotic 3

  • This may help prevent myoglobin precipitation in renal tubules 5

• Consider mannitol if urine output remains inadequate despite fluid resuscitation 3

  • Helps maintain renal perfusion and may act as a free radical scavenger 5

• Monitor for compartment syndrome:

  • Early signs: pain, tension, paresthesia, and paresis 1
  • Late signs: pulselessness and pallor (indicate irreversible damage) 1
  • Consider fasciotomy when compartment pressure exceeds 30 mmHg 1, 2

Laboratory Monitoring

• Repeated bioassessment should include:
  • Plasma myoglobin and CK levels 1
  • Electrolytes, particularly potassium 1
  • Renal function tests (BUN, creatinine) 6
  • Complete electrolyte panel (calcium, phosphorus, magnesium) 1

Special Considerations

• Continue IV fluids until CK levels decrease to <1,000 U/L 3

• Consider renal replacement therapy for:

  • Severe electrolyte abnormalities unresponsive to medical management 2
  • Significant acidosis 4
  • Acute kidney injury with volume overload or uremia 6

• Avoid medications that can exacerbate rhabdomyolysis, particularly succinylcholine 1

Common Pitfalls and Caveats

• Delayed treatment is associated with higher risk of acute kidney injury - early intervention is critical 1

• The classic triad of myalgia, weakness, and pigmenturia is seen in less than 10% of patients, making diagnosis challenging 6

• Mortality rate is approximately 10% and significantly higher in patients who develop acute renal failure 6

• Avoid hypovolemia when using diuretics - maintain adequate fluid status 4

• Continue to investigate underlying causes while providing supportive care to prevent recurrence 6