TY - JOUR
T1 - Bicarbonate and mannitol treatment for traumatic rhabdomyolysis revisited
AU - Nielsen, Jamison S.
AU - Sally, Mitchell
AU - Mullins, Richard
AU - Slater, Matthew
AU - Groat, Tahnee
AU - Gao, Xiang
AU - de la Cruz, J. Salvador
AU - Ellis, Margaret K.M.
AU - Schreiber, Martin
AU - Malinoski, Darren J.
N1 - Funding Information:
This study was supported by grant R49/CCR-006283 from the U.S. Public Health Service , Centers for Disease Control and Prevention , National Center for Injury Prevention and Control , Atlanta, GA.
Publisher Copyright:
© 2016
PY - 2017/1/1
Y1 - 2017/1/1
N2 - 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.
AB - 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.
KW - Acute kidney injury
KW - Alkaline diuresis
KW - Creatine kinase
KW - Mannitol
KW - Rhabdomyolysis
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U2 - 10.1016/j.amjsurg.2016.03.017
DO - 10.1016/j.amjsurg.2016.03.017
M3 - Article
C2 - 27381816
AN - SCOPUS:85002603736
SN - 0002-9610
VL - 213
SP - 73
EP - 79
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 1
ER -