What is the recommended fluid replacement for a patient with rhabdomyolysis?

For a patient with rhabdomyolysis, the recommended fluid replacement involves administering a significant volume of intravenous normal saline, typically at a rate of 1-2 liters per hour. This approach is essential for several reasons.

Firstly, rhabdomyolysis can lead to acute kidney injury due to the release of myoglobin from damaged muscle cells into the bloodstream. Myoglobin is nephrotoxic and can cause obstruction in the renal tubules. Therefore, aggressive hydration with normal saline helps to maintain adequate urine output and dilute myoglobin concentrations in the urine, reducing the risk of kidney damage.

Moreover, the isotonic nature of normal saline helps in maintaining fluid balance without altering electrolyte levels significantly, which is crucial in managing patients who may already have imbalances due to muscle breakdown and potential electrolyte shifts.

In contrast, the alternatives such as dextrose solutions or hypotonic saline do not provide the needed volume or composition that supports effective kidney function. Oral rehydration is generally inadequate in cases of severe rhabdomyolysis, where intravenous access and rapid fluid administration are crucial for patient safety and effective treatment outcomes.