title: Traumatic rhabdomyolysis (crush syndrome) in the rural setting.
abstract: BACKGROUND
  Patients with traumatic rhabdomyolysis (crush syndrome)(CS) secondary to community beatings commonly present to a rural emergency department that has limited access to dialysis services. We describe a retrospective study of patients admitted with a diagnosis of CS to the emergency department of a government hospital in rural KwaZulu-Natal, between November 2008 and June 2009.
  
  
  OBJECTIVE
  We assessed identification and management of these patients, considering: (i) early adverse parameters used to identify poor prognosis, (ii) the importance of early recognition, and (iii) appropriate management with aggressive fluid therapy and alkaline diuresis to prevent progression to renal failure.
  
  
  METHODS
  Diagnosis was based on clinical suspicion and haematuria. Exclusion criteria included a blood creatine kinase level <1 000 U/l on admission. Data captured included demographics, the offending weapon, time of injury and presentation to hospital, and admission laboratory results. Outcome measures included length of time in the resuscitation unit, and subsequent movement to the main ward or dialysis unit, discharge from hospital, or death.
  
  
  RESULTS
  Forty-four patients were included in the study (41 male, 3 female), all presenting within 24 hours of injury: 27 were assaulted with sjamboks or sticks, 43 were discharged to the ward with normal or improving renal function, and 1 patient died.
  
  
  CONCLUSIONS
  Serum potassium, creatinine, and creatine kinase levels were important early parameters for assessing CS severity; 43 patients (98%) had a favourable outcome, owing to early recognition and institution of appropriate therapy - vital in the absence of dialysis services.
authors.affiliation: Ngwelezane Hospital Emergency Department, Empangeni, KwaZulu-Natal.
authors.forename: K J
authors.initials: KJ
authors.lastname: Rosedale
authors.forename: D
authors.initials: D
authors.lastname: Wood
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D003402:Creatine Kinase / Q000097:blood; D003444:Crush Syndrome / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism / Q000628:therapy; D004232:Diuretics / Q000627:therapeutic use; D042241:Early Diagnosis; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006301:Health Services Needs and Demand; D006436:Hemodialysis Units, Hospital; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012206:Rhabdomyolysis / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000628:therapy; D012423:Rural Health / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000600:supply & distribution; D013019:South Africa / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications*
chemical_list: D004232:Diuretics; D003402:Creatine Kinase