Acidosis, Rhabdomyolysis and Hyperkalaemia

  • Fluid resuscitation with IV fluids
  • Use of sodium bicarbonate is controversial. It may be used in severe cases, if acidosis fails to resolve despite correction of hypoxia and adequate fluid resuscitation, although there is no clear evidence for its benefit
  • IV fluid rehydration
  • Consider urinary alkalinisation with sodium bicarbonate. The suggested regime is an initial administration of 225 mmol of 8.4% sodium bicarbonate over 1 hour further doses of sodium bicarbonate will be required to maintain urine pH > 7.5
  • Treat as per standard management protocols

Learning Bite

Good supportive management of the complications of ABD is essential to effective management. Treat hyperthermia with active cooling measures and metabolic acidosis with fluids and consider bicarbonate.