Rhabdomyolysis Management — free guideline decision tool

This tool frames rhabdomyolysis management by CK level, hyperkalemia, and renal function, directing aggressive fluids, monitoring, and dialysis indications.

CK > 1000 → aggressive 0.9% saline, urine output ≥ 200–300 mL/h until CK < 1000/myoglobinuria clears. Hyperkalemia → treat aggressively. Refractory hyperkalemia/severe AKI/volume overload → dialysis. Alkalinization/mannitol not routine.

Use to anchor early aggressive fluid resuscitation, identify hyperkalemia as the most urgent threat, and decide when dialysis is needed.

Mannitol and loop diuretics are never used before volume repletion because they can worsen renal perfusion. (original synthesis · not guideline verbatim) Hyperkalemia is the most pressing threat and drives continuous cardiac monitoring. Hypocalcemia is generally left uncorrected unless symptomatic or accompanying severe hyperkalemia.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: CK level CK > 1000 U/L or > 5× ULN, Hyperkalemia Present, Refractory hyperkalemia / severe AKI / volume overload Present → Result: Disposition Aggressive fluids + manage hyperkalemia（Fluids (cornerstone): Immediate aggressive IV fluids (0.9% normal saline), target urine output ≥ 200–300 mL/h (~3 mL/kg/h), continued until CK falls < 1000 U/L or myoglobinuria clears; do not use mannitol/loop diuretics before fluid repletion (can worsen renal perfusion), diuresis only after adequate volume repletion for volume overload, Hyperkalemia: Hyperkalemia is the most pressing threat: manage as hyperkalemia (calcium to stabilize the myocardium, glucose + insulin and bicarbonate to shift, potassium binders/dialysis to remove), with continuous cardiac monitoring, Monitoring: Electrolytes (potassium/calcium/phosphate/magnesium) every 4–6 h, serial CK/myoglobin/renal function, blood gas, ECG; hypocalcemia generally not corrected (unless symptomatic or severe hyperkalemia), hyperphosphatemia treated with phosphate binders） Inputs: CK level Mildly elevated (< 1000, may still rise), Hyperkalemia Absent, Refractory hyperkalemia / severe AKI / volume overload Absent → Result: Disposition Aggressive fluids + monitoring（Fluids (cornerstone): Mildly elevated CK may still rise (peaks at 24–120 h): give fluids and serially monitor CK and renal function, adjust by volume and urine output; do not use mannitol/loop diuretics before fluid repletion (can worsen renal perfusion), diuresis only after adequate volume repletion for volume overload, Hyperkalemia: Closely monitor potassium (every 4–6 h), watch for lethal hyperkalemic arrhythmias, Monitoring: Electrolytes (potassium/calcium/phosphate/magnesium) every 4–6 h, serial CK/myoglobin/renal function, blood gas, ECG; hypocalcemia generally not corrected (unless symptomatic or severe hyperkalemia), hyperphosphatemia treated with phosphate binders）