Treatment of Myoglobinuria

Immediate Management

Insert a urinary catheter to monitor urine output, pH, and presence of myoglobinuria, as recommended by the Anaesthesia guideline society, to ensure prompt detection of complications 1
Initiate aggressive intravenous hydration to maintain urine output >2 ml/kg/hr, as suggested by the Anaesthesia guideline society, to prevent acute kidney injury 1
Administer sodium bicarbonate to alkalinize the urine, which prevents myoglobin precipitation in renal tubules, as recommended by the Anaesthesia guideline society, to reduce the risk of kidney damage 1

Check electrolytes regularly, particularly potassium, as rhabdomyolysis can lead to life-threatening hyperkalemia, according to the Anesthesiology (ASA) guideline society, to ensure early detection and treatment of electrolyte imbalances 2
Assess for development of compartment syndrome through clinical examination of limbs for swelling, muscle softness, and peripheral pulses, as recommended by the Anaesthesia guideline society, to identify patients at risk of compartment syndrome 1

If compartment syndrome develops, measure compartmental pressures and consider fasciotomies, as recommended by the Anaesthesia guideline society, to prevent further tissue damage 1
For patients with malignant hyperthermia-associated myoglobinuria, administer dantrolene (initial dose 2-3 mg/kg, followed by 1 mg/kg as needed), as suggested by the Anaesthesia guideline society, to reduce the risk of hyperthermia-related complications 3, 4

Treat electrolyte abnormalities, particularly hyperkalemia, with sodium bicarbonate and/or glucose (50 ml 50%) with insulin (10 units), as recommended by the Anaesthesia guideline society, to rapidly correct electrolyte imbalances 3
Avoid calcium administration except in extreme cases, particularly in malignant hyperthermia, as advised by the Anaesthesia guideline society, to prevent worsening of hyperthermia-related complications 3
Perform fasciotomies if compartment syndrome develops, as recommended by the Anaesthesia guideline society, to prevent further tissue damage and improve outcomes 1