Immediate surgical consultation for high suspicion
Remove constrictive dressings
Limb at heart level
Compartment pressure measurement if diagnosis unclear
Monitoring and reassessment loop
Reassessment cadence
Vitals every 15 to 30 minutes if unstable
Lung exam after each bolus
Repeat electrolytes every 2 to 4 hours if severe
Repeat CK every 6 to 12 hours early trend
Urine output hourly tracking
Consultation plan
Early consult triggers
Nephrology for rising creatinine with oliguria
ICU for refractory hyperkalemia or shock
Surgery for compartment syndrome concern
Toxicology for suspected toxin mediated syndrome
Disposition
Level of care criteria
ICU criteria
Refractory hyperkalemia
Hemodynamic instability
Severe heat stroke
Need for renal replacement therapy
Inpatient admission criteria
AKI or rising creatinine
Potassium 6.0 mmol/L or higher
CK very high with ongoing rise
Inability to maintain oral hydration
High risk etiology
Observation pathway criteria
Stable vitals
No AKI
Electrolytes normal or improving
Reliable follow up
Discharge criteria
Discharge requirements
Symptoms improving
Stable renal function trend
Potassium normal
Adequate urine output
Able to maintain oral hydration
Clear etiology and avoidance plan
Follow up timing
Follow up plan
Repeat creatinine and electrolytes within 24 to 72 hours
Primary care follow up within 3 to 7 days
Nephrology follow up if AKI occurred
Discharge Instructions
Copy discharge instructions
Patient facing instructions
You were seen for concern for muscle breakdown called rhabdomyolysis
Drink extra fluids unless you were told to limit fluids for heart or kidney problems
Avoid heavy exercise until cleared by your clinician
Avoid alcohol and recreational drugs
Stop any new supplement that may have contributed
Return immediately for very dark urine, peeing much less, fainting, chest pain, trouble breathing, severe weakness, severe muscle swelling, worsening pain, fever, confusion
Get repeat bloodwork for kidney function and salts in 1 to 3 days as arranged
References
Guideline and key sources
Evidence sources list
KDIGO Clinical Practice Guideline for Acute Kidney Injury 2012
McMahon GM Risk Prediction Score for Kidney Failure or Mortality in Rhabdomyolysis JAMA Internal Medicine 2013
Wilderness Medical Society Clinical Practice Guidelines for Exertional Heat Illness 2019
European Resuscitation Council Guidelines for acute hyperkalemia management 2021 local protocol dependent
Project instructions
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.