Rhabdomyolysis treatment focuses primarily on preventing kidney damage and managing complications caused by the breakdown of muscle tissue. The mainstay of treatment is **aggressive intravenous (IV) fluid administration**, usually isotonic saline, to maintain high urine output and flush out harmful substances like myoglobin that can damage the kidneys. This fluid therapy is typically started as soon as rhabdomyolysis is diagnosed and continued until creatine kinase (CK) levels decrease and kidney function stabilizes.
The goal of IV fluids is to dilute and clear myoglobin and other muscle breakdown products from the bloodstream, reducing their toxic effects on the kidneys. Fluids are often given at rates of 200-300 mL per hour or adjusted based on the patient’s hydration status and urine output. Electrolyte levels such as potassium and calcium are closely monitored and corrected as needed because rhabdomyolysis can cause dangerous imbalances that affect heart and muscle function.
If kidney function deteriorates despite fluid therapy, **renal replacement therapy (dialysis)** may be necessary temporarily to support the kidneys while they recover. Dialysis helps remove waste products and excess fluids when the kidneys cannot do so effectively. This is usually a short-term measure, as most patients regain kidney function with appropriate treatment.
In severe or complicated cases, additional therapies may be considered. For example, **continuous renal replacement therapy (CRRT)** can help maintain fluid and electrolyte balance and may assist in removing myoglobin, although its effectiveness in clearing myoglobin is limited due to the molecule’s size and protein-binding properties. Other experimental or adjunctive treatments include **plasma exchange** and **hemoperfusion**, which aim to remove toxins and inflammatory mediators from the blood, but these are not standard and are used selectively.
Pharmacological approaches are under investigation. Some studies have explored drugs like **Zileuton**, a 5-lipoxygenase inhibitor, which in animal models has shown promise in reducing kidney injury caused by rhabdomyolysis by modulating inflammatory responses. However, such treatments are not yet part of routine clinical care.
Stopping or avoiding any offending agents that triggered rhabdomyolysis is critical. For example, if a medication or supplement is suspected to cause muscle breakdown, it should be discontinued immediately to prevent worsening of the condition.
Supportive care also includes managing symptoms such as muscle pain and nausea, and monitoring for complications like electrolyte disturbances, cardiac arrhythmias, and respiratory issues if muscle weakness affects breathing.
In summary, the treatment of rhabdomyolysis involves:
– **Prompt and aggressive IV fluid resuscitation** to prevent kidney damage.
– **Careful monitoring and correction of electrolytes** to avoid life-threatening imbalances.
– **Temporary dialysis or CRRT** if kidney failure develops.
– **Discontinuation of any causative drugs or toxins**.
– Supportive care for symptoms and complications.
– Experimental therapies like plasma exchange or hemoperfusion may be used in severe cases but are not standard.
Early recognition and treatment are essential to improve outcomes and reduce the risk of long-term kidney damage or other serious complications.
