Thursday, June 12, 2014

            Acute Kidney Injury from Traumatic Rhabdomyolysis

Rhabdomyolysis is most commonly caused by trauma but may also be due to medications, exercise, toxins, infections, muscle enzyme deficiencies or endocrinopathies.


Rhabdomyolysis is associated with elevated levels of creatine kinase. Levels above 5000 U/L are associated with acute kidney injury; and treatment is recommended above this level.


Neither mannitol nor urinary alkalinization with sodium bicarbonate have been convincingly shown to reduce the need for dialysis or mortality from this condition.


The only effective treatment seems to be aggressive intravenous fluid replacement early in the course of the disease. This may require invasive monitoring with either a central line or a pulmonary artery catheter to prevent fluid overload.




REFERENCE:


Brown CV, Rhee P, Chan L, et al. Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference? Journal of Trauma 56 (6), 1191–6.
 Huerta-Alard´ın AL, Varon J, Marik PE (2005) Benchto- bedside review: Rhabdomyolysis—an overview for clinicians. Critical Care 9 (2), 158–69.

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