Management of rhabdomyolysis

1. identify and treat cause

2. treat complications

– hyperK, hypo/hyperCa, hyperphosphataemia; compartment syndrome

3. iv fluids

– main treatment in rhabdomyolysis

– use N saline initially, avoid K-containing fluids

– titrate to urine output of 2 – 3 mls/kg/hr

4. urinary alkalinization

– increases myoglobin clearance by decreasing its solubility in urine

– aim for urine pH > 7.0

– infusion 100 mmol bicarbonate + 900 mls 5% dextrose at 250 mls/hr

– monitor K and bicarbonate levels closely

5. mannitol use

– controversial; theory behind its use is that it is renal vasodilator and increases urine flow thus preventing obstruction from myoglobin casts; may convert oliguric renal failure to non-oliguric renal failure (better prognosis)

– theoretically it can also reduce muscular swelling and prevent compartment syndrome

– make sure the patient receives adequate amounts of fluids before using mannitol

6. haemodialysis

– for established renal failure