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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Rhabdomyolysis may result in life-threatening complications, and all of the potential complications need to be considered during medical care.

For many patients, treatment for muscle breakdown begins in the pre-hospital situation where an emergency medical technician or paramedic recognizes the potential for muscle injury. Intravenous infusion of large amounts of saline fluid helps increase the glomerular filtration rate, or the amount of fluid that is being pushed through the filters located in the kidney. The goal of increased fluid flow is to dilute toxins, such as myoglobin, that may clog and damage the filtering system of the kidney.

In addition, the pre-hospital personnel will consider heart monitoring to evaluate for evidence of hyperkalemia, which can lead to heart rhythm disturbances and sudden cardiac death.

Treatment in the emergency department will continue the pre-hospital care. There is also a need to be concerned about evaluating and caring for the underlying problems that caused the rhabdomyolysis to occur.

Prevention of kidney failure is one of the primary focuses of acute care. Fluid, medication, and potentially dialysis may required to help support kidney function while the circulating myoglobin proteins are cleared from the body.

Hyperkalemia therapy includes monitoring the patient's electrocardiogram (EKG), exploring any abnormalities that may predict potentially fatal heart rhythms such as ventricular tachycardia and ventricular fibrillation. Medications may be used to shift potassium out of the bloodstream and eventually out of the body through the urine.

Disseminated intravascular coagulation is another complication of rhabdomyolysis and may require transfusion of blood clotting products. These may include fresh frozen plasma, cryoprecipitate, and platelets.

Patients who develop complications of rhabdomyolysis often require hospitalization and monitoring. Specialist consultations are considered based upon the patient's status. A nephrologist (kidney specialist) may be needed to advise in regard to the need for dialysis. An orthopedic surgeon may be asked to help if the diagnosis of compartment syndrome is a possibility.

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