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Rhabdomyolysis Fluid Target — ESENeph MCQ

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EasyAcute Kidney InjuryRhabdomyolysis Fluid TargetESENeph

A 30-year-old man develops AKI with dark urine after an intense gym session. His CK is 45000 U/L and creatinine is 350 umol/L. He is started on aggressive IV 0.9% saline. His urine output is 200 mL/hr. What is the fluid therapy target for rhabdomyolysis-induced AKI?

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Correct answer: B — Aggressive IV crystalloid aiming for urine output 200-300 mL/hr (approximately 3 mL/kg/hr) to promote myoglobin washout and prevent tubular obstruction

Rhabdomyolysis-induced AKI requires aggressive IV crystalloid resuscitation targeting high urine output (200-300 mL/hr or ~3 mL/kg/hr) to dilute myoglobin in the tubular lumen, prevent cast formation, and promote myoglobin excretion. Normal saline (0.9%) is the first-line fluid. The role of IV sodium bicarbonate (to alkalinise urine and increase myoglobin solubility) is debated – some centres use it if urine pH <6.5 but evidence is limited. Monitoring for fluid overload (particularly if AKI progresses and urine output falls) and compartment syndrome is essential. RRT is needed if conservative measures fail.

Reference: KDIGO 2012 – AKI; Bosch et al 2009 – Rhabdomyolysis Management