Journal Article

Bicarbonate and mannitol treatment for traumatic rhabdomyolysis revisited

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

2017

Overview

A rhabdomyolysis protocol (RP) with mannitol and bicarbonate to prevent acute renal dysfunction (ARD, creatinine >2.0 mg/dL) remains controversial. 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. 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). Reduced ARD was noted with RP. A prospective controlled study is still warranted. •The 2 major treatments for rhabdomyolysis are alkaline diuresis and crystalloid.•The use of a rhabdomyolysis protocol with mannitol and bicarbonate remains debated.•Use of a rhabdomyolysis protocol was supported for creatinine kinase greater than 10,000 U/L.•Evaluation of rhabdomyolysis strategies in a prospective randomized trial is needed.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Acute kidney injury / Acute Kidney Injury - diagnosis / Acute Kidney Injury - etiology / Acute Kidney Injury - prevention & control / Adult / Age / Algorithms / Alkaline diuresis / Bicarbonates - therapeutic use / Blood pressure / Clinical Protocols / Creatine Kinase / Data analysis / Databases, Factual / Diuretics, Osmotic - therapeutic use / Female / Health risk assessment / Hemodialysis / Humans / Injury Severity Score / Male / Mannitol / Mannitol - therapeutic use / Medical records / Middle Aged / Mortality / Patients / Retrospective Studies / Rhabdomyolysis / Rhabdomyolysis - complications / Software / Studies / Surgery / Urine / Variables / Wounds and Injuries - complications / Young Adult