Management of Rhabdomyolysis in Trauma Patients

Fluid Resuscitation and Electrolyte Management

The American College of Physicians recommends starting aggressive intravenous fluid resuscitation with 0.9% normal saline at 1 liter per hour immediately upon patient contact to prevent acute kidney injury and reduce mortality 1, 2
Establish IV access in an accessible limb, and infuse 0.9% normal saline at 1000 mL/hour during the initial extrication phase, reducing the infusion rate by at least 50% if extrication takes longer than 2 hours 1, 3, 4
Target urine output of 300 mL/hour once bladder catheterization is established, and avoid potassium-containing fluids and starch-based fluids 1, 2, 3, 4
Monitor electrolytes, including potassium, calcium, and phosphorus, every 6-12 hours, and treat hyperkalemia aggressively with standard protocols 2, 5

Initiate dialysis early for refractory hyperkalemia, severe metabolic acidosis, fluid overload, and persistently elevated CK levels after 4 days of adequate hydration 1, 2, 5
Perform early fasciotomy when compartment pressure exceeds 30 mmHg or differential pressure is <30 mmHg, and maintain high suspicion for compartment syndrome 2, 5

Discontinue any medications or supplements that may worsen rhabdomyolysis, such as statins, creatine monohydrate, and red yeast rice 5
Continue intravenous fluids until CK levels decrease, urine output remains adequate, electrolytes normalize, and renal function stabilizes or improves 2, 5