The appearance of tea-coloured urine may be the first clinical sign of rhabdomyolysis. This is confirmed by elevated plasma creatine kinase levels. Prompt, aggressive fluid therapy is key to preventing AKI. This dilutes myoglobin levels, reducing the accumulation of precipitants and toxic by-products in the renal tubules. Alkalinization of the urine is widely believed to reduce myoglobin-induced damage by reversing acidotic conditions. Conventionally sodium bicarbonate has been used to achieve alkalinization, although there is little evidence to support the efficacy of sodium bicarbonate administration over aggressive fluid resuscitation with crystalloid. Mannitol, an osmotic diuretic, is also often included in treatment algorithms despite little evidence to support its use. The theoretical advantages of mannitol in the prevention of rhabdomyolysis-associated AKI is that it acts to reduce tissue edema while increasing the intravascular volume, increases the renal clearance of toxic substances, and also acts as a free radical scavenger.
Posted on: Sun, 21 Dec 2014 15:06:11 +0000