Preventing renal failure in patients with rhabdomyolysis: Do bicarbonate and mannitol make a difference?

Carlos V.R. Brown, Peter Rhee, Linda Chan, Kelly Evans, Demetrios Demetriades, George C. Velmahos

Research output: Contribution to journalReview article

243 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1191-1196
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume56
Issue number6
DOIs
StatePublished - Jun 2004

Keywords

  • Bicarbonate
  • Creatine kinase
  • Dialysis
  • Mannitol
  • Renal failure
  • Rhabdomyolysis
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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