1. Bicarbonate and mannitol treatment for traumatic rhabdomyolysis revisited.
- Author
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Nielsen JS, Sally M, Mullins RJ, Slater M, Groat T, Gao X, de la Cruz JS, Ellis MK, Schreiber M, and Malinoski DJ
- Subjects
- Acute Kidney Injury diagnosis, Acute Kidney Injury etiology, Adult, Algorithms, Clinical Protocols, Creatine Kinase, Databases, Factual, Female, Humans, Injury Severity Score, Male, Middle Aged, Retrospective Studies, Young Adult, Acute Kidney Injury prevention & control, Bicarbonates therapeutic use, Diuretics, Osmotic therapeutic use, Mannitol therapeutic use, Rhabdomyolysis complications, Wounds and Injuries complications
- Abstract
Background: A rhabdomyolysis protocol (RP) with mannitol and bicarbonate to prevent acute renal dysfunction (ARD, creatinine >2.0 mg/dL) remains controversial., Methods: Patients with creatine kinase (CK) greater than 2,000 U/L over a 10-year period were identified. Shock, Injury Severity Score, massive transfusion, intravenous contrast exposure, and RP use were evaluated. RP was initiated for a CK greater than 10,000 U/L (first half of the study) or greater than 20,000 U/L (second half). Multivariable analyses were used to identify predictors of ARD and the independent effect of the RP., Results: Seventy-seven patients were identified, 24 (31%) developed ARD, and 4 (5%) required hemodialysis. After controlling for other risk factors, peak CK greater than 10,000 U/L (odds ratio 8.6, P = .016) and failure to implement RP (odds ratio 5.7, P = .030) were independent predictors of ARD. Among patients with CK greater than 10,000, ARD developed in 26% of patients with the RP versus 70% without it (P = .008)., Conclusion: Reduced ARD was noted with RP. A prospective controlled study is still warranted., (Published by Elsevier Inc.)
- Published
- 2017
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