Treatment

The primary goal of treatment is to prevent kidney damage. Rapid rehydration and kidney profusion is essential with monitoring of urine output and CK levels. Intravenous saline at 1.5 L/hr should be started immediately and continued at a level to insure urine output at 300mL/hr or above. Treatment should continue until the creatine kinase level falls below 1000U/L or there is no detectable myoglobin in the urine. Chelation therapy has been employed in some cases to sequester the uric acid and myoglobin/ferritin casts that cause tubular blockage.

Our patient was hospitalized for 48 hours with a saline drip and released for home monitoring. Her CK level at 10 days was still above 2000U/L. She returned to active exercise in 3 weeks and did complete the trail marathon.

Prevention, as always, is a key component. There have been numerous cases of Rhabdomyolysis in scholastic and collegiate athletes, particularly during summer per-season training. This has led to stricter guideline on practice duration, intensity and monitoring of hydration.