Rhabdomyolysis Pathway Background and Objectives Rhabdomyolysis is a syndrome characterized by the breakdown of skeletal muscle leading to the release of intracellular muscle constituents. The most common etiologies in children are viral illnesses, exercise, and trauma. Muscle pain and muscle weakness are the most common presenting complaints in children and very few present with dark urine. Severity can range from mild elevation in muscle enzymes to life threatening disease secondary to electrolyte imbalance and acute kidney injury, or even acute renal failure. While data for pediatric patients with rhabdomyolysis is limited, the mainstays of treatment are prompt fluid resuscitation and minimizing further muscle damage. Currently at Connecticut Children’s no standardized approach exists for the evaluation in the emergency room, admission criteria, inpatient management, discharge criteria, or post-discharge counseling and follow up recommendations for children presenting with rhabdomyolysis. The objectives of this pathway are to: Establish appropriate admission and discharge criteria for rhabdomyolysis Standardize inpatient management of rhabdomyolysis Decrease the rate of acute renal failure secondary to rhabdomyolysis Algorithm Download Rhabdomyolysis Pathway Algorithm Quality Metrics Percentage of patients with pathway order set usage Percentage of patients receiving 2 normal saline boluses Percentage of patients with appropriate continuous IV fluid administration per pathway recommendation Percentage of patients with rising serum creatinine levels Percentage of patients with acute renal failure secondary to rhabdomyolysis Average length of stay ED (minutes) Average length of stay Inpatient (days) Returns to ED within 30 days Readmissions to hospital within 30 days Educational Module Download Rhabdomyolysis Educational Module Key References Al-Ismaili Z, Piccioni M, Zappitelli M. Rhabdomyolysis: pathogenesis of renal injury and managment. Pediatr Nephrol, 2011 Oct; 26(10): 1781-8. Elsayed EF, Reilly RF. Rhabdomyolysis: a review, with emphasis on the pediatric population.Pediatr Nephrol, 2010 Jan;25(1): 7-18. Mannix R, Tan ML, Wright R, Baskin M. Acute Pediatric Rhabdomyolysis: Causes and Rates of Renal Failure. Pediatrics, 2006 Nov;118(5): 2119-2125. Oshima Y. Characteristics of Drug Associated Rhabdomyolysis: Analysis of 8,610 Cases Reported to the U.S. Food and Drug Administration. Inter Med, 2011;508):845-53. Yang Y, Carter LP, Cook RE, Paul E, Schwartz KR. A Case of Exertional Rhabdomyolysis: A Cheer for Standardizing Inpatient Management and Prevention. Hosp Pediatr. 2016 Dec;6(12):753-756. Zepeda-Orozco D, Ault BH, Jones DP. Factors associated with acute renal failure in children with rhabdomyolysis. Pediatr Nephrol, 2008 Dec;23(12):2281-4. Pathway Contacts Hayley Wolfgruber, MD Robyn Matloff, MD Lana Friedman, MD Disclaimer The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case. View all Clinical Pathways >
