Rhabdomyolysis
Rhabdomyolysis
Patient with muscle pain and CK > 5000
McMahon Score of 8 or less
Cause of Rhabdo identified with reasonable degree of certainty
Crush injury
McMahon Score > 8
Significant electrolyte abnormalities (see respective protocols)
Known or suspected genetic cause with prolonged or severe prior presentations
Trend CK Q8 hours until downward trend established
Stop any offending medications
BMP Q8hr
Pain Control
Fluids
McMahon Score 6 or greater
Fluid Challenge of 150 - 200 ml / hr
If normal bicarb then LR
If acidosis (Bicarb < 20) then use Isotonic bicarb (switch back to LR once Bicarb is 24 or higher)
Monitor Urine Output
Goal Urine output 1-3 ml / kg / hr
If urine output is low or decreases despite fluids, stop fluids and admit
McMahon Score < 6
Consider lower volume LR maintenance (e.g. 75 ml / hr)
Stop fluids when CK < 5000
Disposition
CK < 5000 and downward trend
or
CK downward trend without IV fluids x 8 hours
Pain Controlled
Decrease in UOP despite fluids
Increasing serum creatinine
uncontrolled pain
Significant electrolyte abnormalities