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
- 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.
- Parker CJ. Update on the diagnosis and management of paroxysmal nocturnal hemoglobinuria. ASH Education Book 2016;2016(1):208-16.
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