Clinical Overview

Rhabdomyolysis management requires early identification of any causative compartment syndrome and structured intravenous fluid resuscitation, initiated and continued according to established CK thresholds and monitored through serial urine output and laboratory values.

Treatment Goals

Evidence-based management targets the following measurable endpoints:

Goal urine output of 2–3 mL/kg/hr
Downtrend of serum creatine kinase (CK) below established treatment thresholds
Clearance of myoglobin from the urine

Treatment Approach (Partial Overview)

The protocol begins by addressing any causative compartment syndrome, followed by aggressive intravenous fluid resuscitation — initiated based on CK levels and titrated toward urine output goals. Certain adjunctive agents are specifically not recommended based on current evidence.

The complete structured regimen — including initiation criteria, fluid titration approach, continuation and discontinuation thresholds — is available via the full protocol below.

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.

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What Is the Treatment of Rhabdomyolysis? Fluid Resuscitation, CK Thresholds, and Urine Output Targets

References