Bicarbonate and mannitol treatment for traumatic rhabdomyolysis revisited

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

Research output: Contribution to journalArticle

4 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

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Keywords

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

ASJC Scopus subject areas

  • Surgery

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