Bicarbonate and mannitol treatment for traumatic rhabdomyolysis revisited

Am J Surg. 2017 Jan;213(1):73-79. doi: 10.1016/j.amjsurg.2016.03.017. Epub 2016 Jun 14.

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.

Keywords: Acute kidney injury; Alkaline diuresis; Creatine kinase; Mannitol; Rhabdomyolysis.

MeSH terms

  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / prevention & control*
  • Adult
  • Algorithms
  • Bicarbonates / therapeutic use*
  • Clinical Protocols
  • Creatine Kinase
  • Databases, Factual
  • Diuretics, Osmotic / therapeutic use*
  • Female
  • Humans
  • Injury Severity Score
  • Male
  • Mannitol / therapeutic use*
  • Middle Aged
  • Retrospective Studies
  • Rhabdomyolysis / complications*
  • Wounds and Injuries / complications*
  • Young Adult

Substances

  • Bicarbonates
  • Diuretics, Osmotic
  • Mannitol
  • Creatine Kinase