In rhabdomyolysis, as in tumor lysis syndrome and massive hemolysis, plasma potassium levels may rise very rapidly. Provided that rapid action is taken, it is usually possible to prevent lethal hyperkalemia. The key is to promote and maintain a large diuresis with alkalinization to promote solubility of, for example, myoglobin or urate. Urine outputs of up to 12 l/day have been advocated but 4 to 6 l/day is usually adequate. Following resolution of the acute phase of these syndromes, total body potassium will be low and will require replenishment.
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