Effect of Treatment in Patient with Rhabdomyolysis: Comparison between Single Hydration and Hydration with Urine Alkalinization

ABSTRACT

PURPOSE: Urine alkalinization is commonly used to treat rhabdomyolysis and to prevent the rapid progression of rhabdomyolysis into acute renal failure. However, there are no prospective studies on the beneficial effect of urine alkalinization on rhabdomyolysis. We prospectively examined whether fluid hydration with urine alkalinization treatment would be more effective than single hydration treatment in treating rhabdomyolysis and preventing acute renal failure in the emergency department. METHODS: We performed a prospective randomized trial with fifty-eight patients who were diagnosed with rhabdomyolysis. Thirty-five patients were treated with crystalloid alone, while the others were treated with crystalloid mixed with sodium bicarbonates. Creatine phosphokinase (CPK) and creatinine levels were checked every 4 hours for the first 24 hours and then checked every 8 hours thereafter. Data collected included "peak CPK time"(time from the start of treatment to achievement of the maximal CPK value), increasing and decreasing rate of CPK, and whether acute renal failure developed. RESULTS: Patient's age, sex, initial CPK concentrations, and initial creatinine concentrations were not statistically different between the single hydration treatment group and the hydration with urine alkalinization group. Mean time to peak CPK was 10.2+/-13.7 hours in the single hydration group and 8.1+/-10.2 hours in the hydration with urine alkalinization group. Neither the time to peak CPK nor the CPK change rates was statistically different between the two groups (p=0.547, p=0.176, p=0.696). CONCLUSION: Hydration with urine alkalinization as a treatment for rhabdomyolysis and prevention of acute renal failure did not improve patient results over single hydration treatment.