How to prevent kidney injury in rhabdomyolysis?
The treatment of rhabdomyolysis should be specific to the patient and to the underlying etiology of muscle injury.
Reversal of the underlying cause of muscle injury is of paramount importance.
Volume resuscitation is the key initial therapy in patients with crush syndrome and trauma. Ideally, patients with crush syndrome should be started on intravenous fluids prior to extraction or relief of the compressive injury.
Severe muscle injuries may also require surgical intervention, such as amputation or fasciotomy for compartment syndrome.
The amount of fluid administered should be tailored to the patient and take into account the underlying etiology of muscle injury. In traumatic crush injury cases, 1 to 2 L of isotonic saline should be given as a bolus prior to extraction.
Caution should be utilized in giving excess IV fluid hydration if the patient is oliguric or anuric at presentation.
Patients with traumatic muscle injury or large fluid losses may require 10 to 15 L per day of fluid resuscitation, titrating to a urine output of 200 to 300 mL/hr. The use of chloride-restrictive solutions (e.g., Lactated Ringer’s solution) have been proposed but not studied in this setting.
By comparison, it is inadvisable to administer large amounts of fluid to an elderly patient with heart failure and statin-related rhabdomyolysis.