Management of haemochromogenuria / myoglobinuria / haemoglobinuria

The management of myoglobinuria or haemoglobinuria is best carried out under the guidance of a renal physician. (1,2)

Management steps include:

• increasing a fluid challenge to ensure that the urine output is at least 1-2 mls/kg/hour
• alkalinisation of the urine:
  • reduces urinary crystallisation of haemochromogens
  • add sodium bicarbonate to the resuscitation fluid at 25 mmol/litre of fluids
• forced diuresis:
  • mannitol added to the fluids
  • 12.5 g/litre of fluids

The treatment of paroxysmal nocturnal haemoglobinuria (PNH) is directed at the three major aspects of the disease: intravascular haemolysis, thrombophilia, and marrow hypofunction. (2)

Reference

1. Sawhney JS, Kasotakis G, Goldenberg A, et al. Management of rhabdomyolysis: a practice management guideline from the Eastern Association for the Surgery of Trauma. Am J Surg. 2022 Jul;224(1 pt a):196-204.
2. Parker CJ. Update on the diagnosis and management of paroxysmal nocturnal hemoglobinuria. ASH Education Book 2016;2016(1):208-16.