TY - JOUR
T1 - Preventing renal failure in patients with rhabdomyolysis
T2 - Do bicarbonate and mannitol make a difference?
AU - Brown, Carlos V R
AU - Rhee, Peter
AU - Chan, Linda
AU - Evans, Kelly
AU - Demetriades, Demetrios
AU - Velmahos, George C.
PY - 2004/6
Y1 - 2004/6
N2 - Background: The combination of bicarbonate and mannitol (BIC/MAN) is commonly used to prevent renal failure (RF) in patients with rhabdomyolysis despite the absence of sufficient evidence validating its use. The purpose of this study was to determine whether BIC/MAN is effective in preventing RF in patients with rhabdomyolysis caused by trauma. Methods: This study was a review of all adult trauma intensive care unit (ICU) admissions over 5 years (January 1997-September 2002). Creatine kinase (CK) levels were checked daily (abnormal, >520 U/L). RF was defined as a creatinine greater than 2.0 mg/dL. Patients received BIC/MAN on the basis of the surgeon's discretion. Results: Among 2,083 trauma ICU admissions, 85% had abnormal CK levels. Overall, RF occurred in 10% of trauma ICU patients. A CK level of 5,000 U/L was the lowest abnormal level associated with RF; 74 of 382 (19%) patients with CK greater than 5,000 U/L developed RF as compared with 143 of 1,701 (8%) patients with CK less than 5,000 U/L (p < 0.0001). Among patients with CK greater than 5,000 U/L, there was no difference in the rates of RF, dialysis, or mortality between those who received BIC/MAN and those who did not. Subanalysis of groups with various levels or CK still failed to show any benefit of BIC/MAN. Conclusion: Abnormal CK levels are common among critically injured patients, and a CK level greater than 5,000 U/L is associated with RF. BIC/MAN does not prevent RF, dialysis, or mortality in patients with creatine kinase levels greater than 5,000 U/L. The standard of administering BIC/MAN to patients with posttraumatic rhabdomyolysis should be reevaluated.
AB - Background: The combination of bicarbonate and mannitol (BIC/MAN) is commonly used to prevent renal failure (RF) in patients with rhabdomyolysis despite the absence of sufficient evidence validating its use. The purpose of this study was to determine whether BIC/MAN is effective in preventing RF in patients with rhabdomyolysis caused by trauma. Methods: This study was a review of all adult trauma intensive care unit (ICU) admissions over 5 years (January 1997-September 2002). Creatine kinase (CK) levels were checked daily (abnormal, >520 U/L). RF was defined as a creatinine greater than 2.0 mg/dL. Patients received BIC/MAN on the basis of the surgeon's discretion. Results: Among 2,083 trauma ICU admissions, 85% had abnormal CK levels. Overall, RF occurred in 10% of trauma ICU patients. A CK level of 5,000 U/L was the lowest abnormal level associated with RF; 74 of 382 (19%) patients with CK greater than 5,000 U/L developed RF as compared with 143 of 1,701 (8%) patients with CK less than 5,000 U/L (p < 0.0001). Among patients with CK greater than 5,000 U/L, there was no difference in the rates of RF, dialysis, or mortality between those who received BIC/MAN and those who did not. Subanalysis of groups with various levels or CK still failed to show any benefit of BIC/MAN. Conclusion: Abnormal CK levels are common among critically injured patients, and a CK level greater than 5,000 U/L is associated with RF. BIC/MAN does not prevent RF, dialysis, or mortality in patients with creatine kinase levels greater than 5,000 U/L. The standard of administering BIC/MAN to patients with posttraumatic rhabdomyolysis should be reevaluated.
KW - Bicarbonate
KW - Creatine kinase
KW - Dialysis
KW - Mannitol
KW - Renal failure
KW - Rhabdomyolysis
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=3142594033&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=3142594033&partnerID=8YFLogxK
U2 - 10.1097/01.TA.0000130761.78627.10
DO - 10.1097/01.TA.0000130761.78627.10
M3 - Review article
C2 - 15211124
AN - SCOPUS:3142594033
SN - 0022-5282
VL - 56
SP - 1191
EP - 1196
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 6
ER -