Bicarbonate and mannitol treatment for traumatic rhabdomyolysis revisited

Jamison S. Nielsen, Mitchell Sally, Richard J. Mullins, Matthew Slater, Tahnee Groat, Xiang Gao, J. Salvador de la Cruz, Margaret K.M. Ellis, Martin Schreiber, Darren J. Malinoski

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)73-79
Number of pages7
JournalAmerican journal of surgery
Volume213
Issue number1
DOIs
StatePublished - Jan 1 2017

Keywords

  • Acute kidney injury
  • Alkaline diuresis
  • Creatine kinase
  • Mannitol
  • Rhabdomyolysis

ASJC Scopus subject areas

  • Surgery

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