Fluid resuscitation and systemic complications in crush syndrome: 14 Hanshin-Awaji earthquake patients.
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.
Shimazu
T
T
Department of Traumatology, Osaka University Medical School, Japan.
Yoshioka
T
T
Nakata
Y
Y
Ishikawa
K
K
Mizushima
Y
Y
Morimoto
F
F
Kishi
M
M
Takaoka
M
M
Tanaka
H
H
Iwai
A
A
Hiraide
A
A
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
D007527:Isoenzymes; D003404:Creatinine; D003402:Creatine Kinase