ما هو علاج انحلال الربيدات العضلية؟ الإنعاش بالسوائل، وعتبات CK، وأهداف إخراج البول

References

DOI: 10.1016/j.amjsurg.2021.11.022R

• The first principle in the treatment of rhabdomyolysis should be the identification and release of any causative compartment syndrome.
• After performing an extensive literature search and assessing the existing evidence, we conditionally recommend using aggressive IVFR in the management of patients with rhabdomyolysis.
• We would recommend initiating treatment for CK levels greater than 5000–10,000 U/L as commonly used treatment thresholds.
• A recent review recommended starting with 1 L boluses and then titrating fluids to higher urine output goals.
• We recommend continued treatment with IVFR until a predefined threshold is reached such as the CK levels downtrend below 5000–10,000 U/L or myoglobin is cleared from the urine.
• We conditionally recommend against the use of bicarbonate or mannitol in patients with rhabdomyolysis, as no clear benefit was demonstrated in our meta-analysis, and there may be risks associated with these treatments.
• We support a UOP goal of 2–3 mL/kg/hr for patients undergoing IVFR which is in the middle range of published reports.