title: Fluid resuscitation and systemic complications in crush syndrome: 14 Hanshin-Awaji earthquake patients.
abstract: BACKGROUND
  Crush syndrome is a form of traumatic rhabdomyolysis characterized by systemic involvement, in which acute renal failure is potentially life-threatening.
  
  
  METHODS
  Clinical and laboratory data of 14 crush-syndrome patients transferred to a tertiary emergency department after the Hanshin-Awaji earthquake were analyzed. The patients were buried under collapsed houses for the average of 6.7 +/- 5.7 (SD) hours (range, 1 to 24 hours). They were referred to us 6 to 250 hours after the earthquake.
  
  
  RESULTS
  Of those who arrived at our institution within 40 hours, 25% (two of eight) developed renal failure, whereas all six patients who arrived after 40 hours developed renal failure. Peak serum creatine kinase ranged from 6,677 to 134,200 U/L (51,674 +/- 41,776). Renal failure was highly associated with massive muscle damage (serum creatine kinase above 25,000 U/L) and insufficient initial fluid resuscitation (below 10,000 mL/2 days).
  
  
  CONCLUSIONS
  Prompt and adequate, if not massive, fluid resuscitation is the key to preventing renal failure after such injury.
authors.affiliation: Department of Traumatology, Osaka University Medical School, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Shimazu
authors.forename: T
authors.initials: T
authors.lastname: Yoshioka
authors.forename: Y
authors.initials: Y
authors.lastname: Nakata
authors.forename: K
authors.initials: K
authors.lastname: Ishikawa
authors.forename: Y
authors.initials: Y
authors.lastname: Mizushima
authors.forename: F
authors.initials: F
authors.lastname: Morimoto
authors.forename: M
authors.initials: M
authors.lastname: Kishi
authors.forename: M
authors.initials: M
authors.lastname: Takaoka
authors.forename: H
authors.initials: H
authors.lastname: Tanaka
authors.forename: A
authors.initials: A
authors.lastname: Iwai
authors.forename: A
authors.initials: A
authors.lastname: Hiraide
mesh_terms: D003402:Creatine Kinase / Q000097:blood; D003404:Creatinine / Q000097:blood; D003444:Crush Syndrome / Q000097:blood / Q000150:complications* / Q000628:therapy*; D004190:Disasters; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007527:Isoenzymes; D007564:Japan; D007677:Kidney Function Tests; D008297:Male; D012017:Referral and Consultation; D012151:Resuscitation / Q000379:methods*; D013997:Time Factors
chemical_list: D007527:Isoenzymes; D003404:Creatinine; D003402:Creatine Kinase