Management of Rhabdomyolosis

12 Jul

RAGING HYPOTHETICAL:

–A 90 year old female presents from SNF after being found on the floor overnight for an unknown amount of time. Her GCS is below baseline and is subsequently intubated. Labs are consistent with a gap acidosis and a CK >1000. What now?

KEY POINTS:

•NO RCTS of acute management. All treatment guidelines are based on expert opionion

Complications of acute rhabdo:

Hypovolemia secondary to necrosis of muscle tissue and subsequent vasodilation

Compartment syndrome

Arrhythmias and cardiac arrest

DIC

acute renal failure

Hepatic Dysfunction

Emergency Management:

Aggressive CRYSTALLOID infusion (maintain UOP >150ml/hr)

Check limbs for compartment syndrome

–As an ADJUNCT to crystalloid infusion, consider a 20%mannitol infusion of 0.5gm/kg over 15 mins and a HCO3 gtt. (ALL EXPERT OPINON)

–Agreesive correction of hyperkalemia

Correct hypocalcemia only if symptomatic

Submitted by W. Rushton.

Reference(s): FY Khan. Rhabdomyolysis: A Review of the Litterature The Netherlands Journal of Medicine October 2009, Vol 67, No 9; picture

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