Rhabdomyolysis — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] CK threshold
   Is CK >5× ULN (>1000 U/L)? (Muscle breakdown releases myoglobin, CK and electrolytes. Diagnosis CK >5× upper limit of normal (>1000 U/L); ≥5000 is severe with markedly increased AKI risk; the classic triad (myalgia, weakness, tea/red-brown urine) appears in <10% and many have no muscle symptoms. Check CK, renal function, electrolytes (potassium/phosphate/calcium), urine myoglobin, blood gas.)
   • Confirmed/highly suspected → Aggressive fluids + correct electrolytes
   • Mildly raised CK, low suspicion → Mild · observe
2. [End] Mild · observe
   Mildly raised CK, low suspicion: fluids, find and treat the trigger, recheck CK and renal function; if CK rises or tea-colored urine/oliguria appears, manage as rhabdomyolysis.
3. [End] Aggressive fluids + correct electrolytes
   1) Early aggressive isotonic saline (the core measure to prevent AKI): often start 1–2 L/h in severe cases, target urine output ≥200–300 mL/h, titrate to volume and urine output. 2) Monitor and correct electrolytes — focus on hyperkalemia (lethal), hyperphosphatemia, hypocalcemia (do not replace if asymptomatic), metabolic acidosis. 3) Treat the trigger, stop offending drugs, relieve crush. 4) Watch for compartment syndrome, DIC, arrhythmia. 5) Refractory AKI/severe hyperkalemia/volume overload/severe acidosis → renal replacement therapy. Urine alkalinization has weak evidence and is not routine.

Source guidelines & references

• Rhabdomyolysis diagnosis and management (Merck Manual; StatPearls)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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