Rhabdomyolysis: Electrolyte Abnormalities and Management

Electrolyte Abnormalities

• Hyperphosphatemia occurs in the acute phase of rhabdomyolysis due to the release of phosphate from injured muscle cells, which can worsen kidney injury through calcium-phosphate complex deposition in renal tissue 1
• Hypokalemia and hypophosphatemia do not occur in the acute phase of rhabdomyolysis, but may develop later during recovery or with aggressive dialysis treatment 2, 3

Management Considerations

• The American Society of Nephrology recommends continuous cardiac monitoring for hyperkalemia-induced arrhythmias and urgent treatment of hyperkalemia if severe (>6 mmol/L) with insulin/glucose, calcium, and potentially dialysis 1
• Close monitoring of all electrolytes is necessary given the potential for life-threatening derangements, as recommended by the National Kidney Foundation 3