From the Guidelines
Patients with rhabdomyolysis should not be kept NPO (nothing by mouth) unless they have specific complications requiring it, and instead, aggressive fluid resuscitation should be initiated to prevent acute kidney injury. The management of rhabdomyolysis focuses on preventing acute kidney injury, which can be achieved through aggressive fluid resuscitation, aiming for a high urine output of 200-300 mL/hour 1. According to the guidelines for the acute care of severe limb trauma patients, which include cases of rhabdomyolysis, the volume to be administered remains debated, but a retrospective study concluded that volumes greater than 6L were required in patients with severe rhabdomyolysis to prevent acute kidney injury 1. Some key points to consider in the management of rhabdomyolysis include:
- Aggressive fluid resuscitation with isotonic saline at 1-2 L/hour initially, alongside oral intake if the patient can tolerate it
- Monitoring for electrolyte abnormalities, particularly hyperkalemia, hypocalcemia, and hyperphosphatemia
- Close tracking of kidney function
- Addressing the underlying cause of rhabdomyolysis while maintaining adequate hydration
- Considering NPO status only if the patient has specific complications, such as severe nausea, vomiting, altered mental status, or requires mechanical ventilation.
From the Research
Rhabdomyolysis Patient Management
- The management of rhabdomyolysis involves early detection, treatment of the underlying cause, and prevention of acute renal failure 2.
- Aggressive intravenous fluid resuscitation (IVFR) is conditionally recommended to improve outcomes of acute renal failure (ARF) and lessen the need for dialysis in patients with rhabdomyolysis 3.
- Early and aggressive fluid resuscitation to restore renal perfusion and increase urine flow is agreed on as the main intervention for preventing and treating acute kidney injury (AKI) 4, 5.
NPO Status for Rhabdomyolysis Patients
- There is no direct evidence in the provided studies to support or refute the use of NPO (nil per os) status for rhabdomyolysis patients.
- The focus of treatment is on aggressive fluid resuscitation, management of electrolyte abnormalities, and prevention of acute renal failure, rather than dietary restrictions 3, 4, 5, 2, 6.
Treatment Goals
- The primary goals of treatment for rhabdomyolysis are to prevent acute renal failure, manage electrolyte abnormalities, and identify and treat potentially life-threatening complications 4, 6.
- Treatment should be individualized based on the underlying cause of rhabdomyolysis, the severity of symptoms, and the patient's overall clinical condition 3, 2.