How is rhabdomyolysis managed in methamphetamine toxicity?

Updated: Aug 15, 2018
  • Author: John R Richards, MD, FAAEM; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

Suspect rhabdomyolysis and follow creatine kinase (CK) levels in patients who present to the ED with severe agitation from methamphetamine or have had prolonged periods of immobilization. Management of rhabdomyolysis is as follows:

  • Administer aggressive volume therapy with IV crystalloid

  • Admit the patient to the hospital after obtaining nephrology consultation

  • Closely monitor renal function, vital signs, and fluid input and output

  • Administration of sodium bicarbonate prevents precipitation of myoglobin in renal tubules by preventing acidic urine pH

  • Early and aggressive fluid and electrolyte treatment of potential rhabdomyolysis can improve the clinical outcome and decrease potential nephrotoxicity; however, hemodialysis may be necessary in certain severe cases


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