How electrolyte abnormalities managed in rhabdomyolysis?
Hyperkalemia in rhabdomyolysis should be managed in a similar fashion to hyperkalemia from other causes.
However, the potassium load may be very large, and patients who receive dialysis for hyperkalemia may develop post-dialysis “rebound” hyperkalemia, so potassium should be monitored frequently, even after dialysis.
Serum calcium levels often decline early, but replacing calcium may exacerbate muscle calcium deposition and can lead to rebound hypercalcemia as the calcium leaves myocytes during the recovery period.
Indications for calcium replacement include symptomatic hypocalcemia (e.g., seizures, tetany), ionized serum calcium <0.8 mmol/L, and severe hyperkalemia with electrocardiogram changes.
High phosphorus levels in rhabdomyolysis are difficult to manage and usually respond poorly oral PO 4 binder medications.
As muscle injury resolves and kidney injury improves, hyperphosphatemia usually resolves.