How is rhabdomyolysis treated?

• A. Generous amounts of intravenous fluids to dilute and flush myoglobin; dialysis in the worst cases.
• B. Bed rest and NSAIDs.
• C. Antibiotics.
• D. A high-protein diet.

Answer: (A)

Aggressive IV fluid resuscitation is the mainstay of rhabdomyolysis treatment. When muscle cells break down, they release myoglobin into the bloodstream, which can damage the kidneys. Giving generous amounts of isotonic fluids helps maintain kidney perfusion, dilutes the myoglobin, and promotes its clearance through the urine. The practical goal is to keep urine output adequate (roughly 0.5–1 mL/kg/hour in adults) to protect the kidneys.

In some cases, clinicians may use bicarbonate to alkalinize the urine, which can help reduce myoglobin precipitation in the renal tubules, though evidence for this approach varies. Dialysis becomes necessary only in the most severe situations—such as established acute kidney injury with rising potassium, severe acidosis, or fluid overload not responding to fluids.

Options like bed rest with NSAIDs, antibiotics, or a high-protein diet don’t address the kidney-protective strategy needed in rhabdomyolysis and can even worsen kidney function, which is why they aren’t appropriate primary treatments.