Other Considerations

Rhabdomyolysis can lead to cardiac arrhythmias as a consequence of metabolic acidosis and hyperkalaemia. These disturbances are as important to correct as the arrhythmia itself.

There are two treatments which are unproven and are considered here, the administration of sodium bicarbonate and the use of mannitol.

Administration of sodium bicarbonate

Sodium bicarbonate has been long advocated as a treatment for rhabdomyolysis.

The theory was alkalinisation of the urine would clear an increasingly acid load delivered to the kidney.

There is no evidence to substantiate this. Furthermore large doses of bicarbonate may worsen the hypocalcaemia especially if hypovolaemia is corrected.

It is likely that large volume of crystalloid alone will produce a diuresis sufficient to alkalinise urine.

Use of mannitol

Mannitol has been suggested, and demonstrated in experimental models, to produce a diuresis that protects against renal failure.

However robust evidence is lacking from the literature to confirm its efficacy.

Mannitol, like furosemide, is a renal vasodilator and osmotic diuretic and both have been used to attempt to initiate diuresis when the patient becomes anuric.

Again there is little evidence and retrospective studies suggest there is no additional benefit over fluid hydration.

The prognosis in rhabdomyolysis is related to coexistent illness and injury but the renal failure is usually reversible.