Myoglobinuria Medication

Updated: Jan 06, 2017
  • Author: Prasad Devarajan, MD, FAAP; Chief Editor: Craig B Langman, MD  more...
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Medication

Medication Summary

In patients with myoglobinuria, administer a sodium chloride solution for volume depletion as 0.9% NaCl solution, lactated Ringers solution, or a solution of 0.45% NaCl and sodium bicarbonate 50 mEq/L. Mannitol may be administered to facilitate osmotic diuresis. Diuretics such as furosemide are less desirable because they may accentuate intravascular volume depletion.

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Osmotic diuretics

Class Summary

These agents raise the osmolality of plasma and renal tubular fluid, which creates an osmotic inhibition of water transport in the proximal tubule. This effect subsequently decreases the gradient for passive sodium absorption in the ascending limb of the loop of Henle. The increased urinary flow is achieved by means of nonelectrolyte solute diuresis. Increased glomerular filtration rate may also be observed.

Mannitol (Osmitrol)

Osmotic diuretic. Inhibits tubular reabsorption of electrolytes by increasing osmotic pressure of glomerular filtrate. Increases urinary output.

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Alkalinizing agents

Class Summary

Sodium bicarbonate is used as a gastric, systemic, and urinary alkalinizer. Sodium bicarbonate is administered IV to alkalinize the urine in patients with rhabdomyolysis because it may prevent the toxicity that can result from the presence of myoglobin in acidic urine and prevent the crystallization of uric acid.

Sodium bicarbonate

Useful in alkalizing urine to prevent acute myoglobinuric renal failure. Titrate dose to increase pH >7, usually available as 1 mEq/mL. Add to 0.45% NaCl to deliver 1-2 mEq/kg/d.

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