- Either lactated Ringer’s solution or saline (0.9% or 0.45%) is an acceptable fluid for resuscitation in rhabdomyolysis. A starting rate of 400 mL/hour can be initiated, with goal-directed therapy of urine output of 1 mL/kg/hour to 3 mL/kg/hour, and up to 300 cc/hour.
- Clinical studies evaluating the efficacy of sodium bicarbonate and/or diuretic use (mannitol, loop diuretics) for prevention of rhabdomyolysis-induced AKI are limited by a lack of appropriate control groups, standardized definitions, retrospective design, and low statistical power. Given these significant limitations, the use of sodium bicarbonate or diuretics for prevention of AKI in rhabdomyolysis is not recommended.
- Hyperkalemia, hyperphosphatemia, and hypocalcemia are electrolyte abnormalities most commonly encountered when treating rhabdomyolysis. Correcting biochemical equilibrium and electrolytes during rhabdomyolysis should proceed meticulously to avoid complications from treatment. Hyperkalemia is the electrolyte abnormality that requires timely correction to reduce risk of cardiac arrhythmia.
- There is no role for RRT (either continuous (CRRT) or intermittent) in rhabdomyolysis to prevent AKI. The utilization of RRT in patients with rhabdomyolysis should be based on traditional indications for AKI and the degree of renal impairment.
- In patients with rhabdomyolysis who develop AKI and need RRT, either CRRT or intermittent RRT should be used based on the degree of renal impairment and the clinical status of the patient. There are no recommendations regarding RRT modalities (filtration vs. diffusion), filter type (low vs. high cut-off membranes), or high-flow versus low-flow dialysis.
- Clinicians should monitor for a variety of complications, ranging from an asymptomatic elevation of muscle protein to an accumulation of electrolyte imbalances, edema, and toxic cellular components. Morbidity can present early or late, including hyperkalemia, hepatic dysfunction, cardiac dysfunction, AKI, acute renal failure (ARF), disseminated intravascular coagulation (DIC), and compartment syndrome. AKI is the most common systemic complication of rhabdomyolysis and is responsible for most of the morbidity and mortality associated with rhabdomyolysis.
- The risk of AKI, RRT, and/or in-hospital mortality in patients with rhabdomyolysis can be estimated using admission demographic, clinical, and laboratory variables. Risk prediction scores may not directly influence treatment; however, they may be useful in estimating prognosis and setting expectations. As no single laboratory value is sufficient to predict the course of rhabdomyolysis, a combined index of metrics, the McMahon Score (table 1), may be calculated at admission for prognostication.3 A score greater than or equal to 6 is predictive of a need for high-volume fluid resuscitation, RRT, and death.
Rhabdomyolysis consensus summary
|Large burden of injury involving muscle.
Vascular injury or muscle ischemia.
Extreme exertional demands/toxins.
|May be asymptomatic.
Acute muscle weakness.
Pain/tender/swelling involved extremity.
January 25, 2022
Country of Publication
Rhabdomyolysis is a condition characterized by primary (mechanical) or secondary (metabolic) skeletal muscle injury, resulting in cell death and release of potentially toxic substances into circulation. Management often centers on prevention or treatment of the primary complication of the condition, acute kidney injury (AKI). Here we briefly review the causes, diagnosis, management, and outcomes of rhabdomyolysis.
Male, Female, Adult, Older adult
Health Care Settings
Emergency care, Hospital, Operating and recovery room
Physician, nurse, nurse practitioner, physician assistant
D012206 - Rhabdomyolysis
Kodadek L, Carmichael Ii SP, Seshadri A, Pathak A, Hoth J, Appelbaum R, Michetti CP, Gonzalez RP. Rhabdomyolysis: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document. Trauma Surg Acute Care Open. 2022 Jan 27;7(1):e000836. doi: 10.1136/tsaco-2021-000836. PMID: 35136842; PMCID: PMC8804685.