How is rhabdomyolysis managed in heat stroke?

Updated: Nov 06, 2018
  • Author: Robert S Helman, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

The occurrence of rhabdomyolysis may be heralded by the development of dark, tea-colored urine and tender edematous muscles. Rhabdomyolysis releases large amounts of myoglobin, which can precipitate in the kidneys and result in acute kidney injury (AKI). Renal failure especially is common in patients who develop hypotension or shock during the course of their disease and may occur in as many as 25-30% of patients with EHS.

Treatment of rhabdomyolysis involves infusion of large amounts of intravenous fluids (fluid requirements may be as high as 10 L), alkalinization of the urine, and infusion of mannitol. Fluid administration is best guided by invasive hemodynamic parameters, and urine output should be maintained at 3 mL/kg/h to minimize the risk of renal failure.

Alkalinization of the urine (to a pH of 7.5-8.0) prevents the precipitation of myoglobin in the renal tubules and may control acidosis and hyperkalemia in acute massive muscle necrosis. Mannitol may improve renal blood flow and glomerular filtration rate, increase urine output, and prevent fluid accumulation in the interstitial compartment (through its osmotic action). Mannitol also is a free radical scavenger and, therefore, may reduce damage caused by free radicals. Once renal failure occurs, dialysis is the only effective therapeutic modality for rhabdomyolysis.


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