Treatment of rhabdomyolysis
The first line of treatment is to
obtain IV access with a large bore catheter and administer isotonic crystalloid
500cc/h. the goal is to maintain a urine output of 200-300 cc/h (Craig, 2008).
Repeat CK levels every 6-12 hours to determine peak CK level.
Urine
alkalinization is recommended for patients with rhabdomyolysis and CK
levels in excess of 6000 IU/L. The suggested treatment is .5
isotonic sodium chloride solution with one ampule of sodium bicarbonate
administered at 100cc/h and titrated for
a pH higher than 7 (Craig, 2008). Mannitol may be administered to enhance renal
perfusion. Mannitol increases urine output, washes out myoglobin in the
tubules, and expands the intravascular volume (Luck, Verbin, 2008).
Treatment of Acute Renal Failure
Treatment of ATN is primarily aimed at “flushing” the
kidneys. The single most important
treatment is fluid resuscitation to restore intravascular volume to flush out
tubular debris. Crystalloid fluids are
given at a rate of at least 1 liter per hour to keep urine output 150 to 300 cc
per hour, necessitating a urine catheter.
Assessing for fluid overload, pulmonary edema and compartment syndrome
is essential, particularly in the presence of oliguria. Sodium bicarbonate is given to alkalinize the
urine to keep the urine pH greater than six.
Administration of Mannitol is controversial. It is an osmotic diuretic that preserves
intravascular volume while flushing out cellular debris but it may worsen
hypovolemia. (Wilson, 2006). Furesomide
may be given to promote diuresis in the presence of oliguria but must be
administered carefully since it may acidify the urine. (Criddle, 2003). In some severe cases of acute renal failure
dialysis may be necessary. It is
important to avoid other nephrotoxic agents e.g. aminoglycosides or contrast
medium. Prognosis is good with prompt
treatment with renal function returning to normal with one to two months (Wilson, 2006) .
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