American Board of Family Medicine (ABFM) Practice Exam

Which of the following treatments is commonly recommended for rhabdomyolysis to prevent acute kidney injury?

1. Loop diuretics

2. Mannitol

3. Isotonic saline

4. Parenteral corticosteroids

The correct answer is: Isotonic saline

The recommended treatment for rhabdomyolysis to prevent acute kidney injury is the administration of isotonic saline. Rhabdomyolysis occurs when muscle tissue breakdown leads to the release of myoglobin into the bloodstream, which can harm the kidneys. One of the most critical steps in managing this condition is maintaining adequate renal perfusion and preventing the precipitation of myoglobin in the renal tubules. Isotonic saline is specifically beneficial because it helps to dilute the concentration of myoglobin in the renal circulation and enhances urinary flow, facilitating the excretion of myoglobin. This hydration effectively reduces the risk of acute tubular necrosis, which is a common complication associated with rhabdomyolysis. When considering alternative treatments, while loop diuretics and mannitol may also be used in certain clinical scenarios, they are more commonly adjunctive therapies rather than first-line preventative measures against acute kidney injury. Loop diuretics might be considered to promote diuresis, yet they do not provide the same primary benefit in preventing kidney damage as isotonic saline does. Mannitol can help maintain urine flow and has some renal protective properties, but it is not universally recommended for all cases of rhabdomyolysis due to potential side effects and