Rhabdomyolysis: advances in diagnosis and treatment

Rhabdomyolysis is a potentially life-threatening condition caused by a breakdown of skeletal muscle and the release of the intracellular contents into the circulatory system. There are many possible causes, including crush injury, excessive muscular activity, medications, infections, and varied metabolic, connective tissue, rheumatologic, and endocrine disorders. It is vital that emergency clinicians consider the diagnosis when patients present with circumstances known to be high-risk for rhabdomyolysis, including intoxication, prolonged immobilization, and/or altered mentation. Optimal crystalloid selection is still debated, but immediate, aggressive intravenous volume expansion is indicated to prevent myoglobinuric renal failure. Serum potassium levels must be obtained and electrocardiograms must be evaluated to identify life- and limb-threatening complications of hyperkalemia. This review examines the current evidence on symptoms and diagnostic methods as well as standard first-line treatments of rhabdomyolysis. In addition, evidence from animal models on urine alkalinization with sodium bicarbonate infusion is discussed.