Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference?
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 of CK still failed to show any benefit of BIC/MAN.


CONCLUSIONS
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 post-traumatic rhabdomyolysis should be reevaluated.
Brown
Carlos V R
CV
Department of Surgery, Division of Trauma and Critical Care, University of Southern California and the Los Angeles County Medical Center, Los Angeles, California, USA. carlosbr@usc.edu
Rhee
Peter
P
Chan
Linda
L
Evans
Kelly
K
Demetriades
Demetrios
D
Velmahos
George C
GC
D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology* / Q000517:prevention & control*; D003402:Creatine Kinase / Q000097:blood*; D004234:Diuretics, Osmotic / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008353:Mannitol / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D016017:Odds Ratio; D012206:Rhabdomyolysis / Q000097:blood / Q000150:complications*; D012307:Risk Factors; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use*
D004234:Diuretics, Osmotic; D008353:Mannitol; D017693:Sodium Bicarbonate; D003402:Creatine Kinase