From the Guidelines
The treatment plan for rhabdomyolysis should prioritize aggressive intravenous fluid resuscitation with normal saline at rates of 200-300 mL/hour initially, to maintain urine output above 200-300 mL/hour, as evidenced by recent guidelines 1. This approach is crucial in preventing kidney injury by diluting myoglobin and promoting its excretion. Key considerations in the management of rhabdomyolysis include:
- Correcting electrolyte abnormalities, particularly hyperkalemia, which may require calcium gluconate, insulin with glucose, sodium bicarbonate, or potassium binders like sodium polystyrene sulfonate 1.
- Identifying and addressing the underlying cause of rhabdomyolysis, whether it's medication-related, trauma, or another condition.
- Pain management with acetaminophen is preferred over NSAIDs, which can worsen kidney stress.
- Monitoring includes regular checks of creatine kinase levels, kidney function, and electrolytes until values normalize.
- Patients should avoid physical activity during recovery and maintain adequate hydration after discharge.
- Follow-up should occur within 1-2 weeks to ensure complete resolution and assess for any chronic kidney damage. It's also important to note that raising CPK levels above five times normal (approximately 1000 IU/L) is a sign of rhabdomyolysis, and myoglobin is responsible for intraluminal kidney tubular obstruction resulting in reduced glomerular filtration rate 1. Severe cases may need renal replacement therapy such as hemodialysis, and the measurement of plasma myoglobin may be more sensitive and specific than CPKs in identifying the risk of acute kidney injury 1.
From the Research
Treatment Plan for Rhabdomyolysis
The treatment plan for rhabdomyolysis typically involves:
- Aggressive intravenous fluid resuscitation to prevent myoglobinuric renal failure 2, 3, 4, 5
- Correction and prevention of electrolyte abnormalities, such as hyperkalemia 2, 4, 5
- Monitoring for complications, including acute renal failure, compartment syndrome, and cardiac dysrhythmias 3, 4, 5
- Consideration of urine alkalization with sodium bicarbonate, although its benefits are still debated 3, 4, 5
Key Components of Treatment
- Early and aggressive intravenous fluid resuscitation is crucial in preventing acute kidney injury and improving outcomes 2, 3, 4, 5
- The use of bicarbonate and mannitol is not recommended, as they have not been shown to improve outcomes in patients with rhabdomyolysis 3
- Hospitalization and close monitoring are essential in managing rhabdomyolysis and preventing complications 4, 5, 6