title: Prevention of kidney injury following rhabdomyolysis: a systematic review.
abstract: OBJECTIVE
  To conduct a systematic literature review to evaluate evidence-based recommendations for the prevention of rhabdomyolysis-associated acute renal failure (ARF).
  
  
  METHODS
  PubMed (1966-December 2012), International Pharmaceutical Abstracts, Science Citation Index, and Cochrane databases (1970-December 2012) were searched. There were no language restrictions.
  
  
  METHODS
  Studies selected dealt with treatment of rhabdomyolysis (crush syndrome) or prevention of ARF in patients with rhabdomyolysis. Articles excluded did not present original data or described only the management of ARF after it developed. Single case reports were excluded. Extracted data included study type; population; definitions of rhabdomyolysis and ARF; fluid, sodium bicarbonate, and mannitol dosages; and study findings.
  
  
  RESULTS
  Twenty-seven studies met the inclusion criteria. No controlled trials compared intravenous fluid administration plus sodium bicarbonate to fluid administration alone. Three concluded that there was no significant difference in the rates of ARF between patients receiving and those not receiving sodium bicarbonate; however, urine alkalinization was not documented. Eight investigations concluded that delayed fluid administration increased the risk of ARF. No controlled study compared volumes of fluid administered or targeted urine output goals. Fluid type, therapy duration, and monitoring parameters varied widely; 4 used a urine output goal in adults of more than 300 mL/h or 300 mL/h or more. No evidence supported a preferred fluid type or that sodium bicarbonate with or without mannitol was superior to fluid therapy alone.
  
  
  CONCLUSIONS
  Intravenous fluids should be initiated as soon as possible, preferably within the first 6 hours after muscle injury, at a rate that maintains a urine output in adults of 300 mL/h or more for at least the first 24 hours. Sodium bicarbonate should be administered only if necessary to correct systemic acidosis and mannitol only to maintain urine output of 300 mL/h or more despite adequate fluid administration.
authors: West Virginia Poison Center, and West Virginia University Department of Clinical Pharmacy, West Virginia University, Charleston Division, Charleston, WV, USA. escharman@hsc.wvu.edu
authors: Elizabeth J
authors: EJ
authors: Scharman
authors: William G
authors: WG
authors: Troutman
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000818:Animals; D004305:Dose-Response Relationship, Drug; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D008353:Mannitol / Q000008:administration & dosage / Q000627:therapeutic use; D012206:Rhabdomyolysis / Q000150:complications*; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D008353:Mannitol; D017693:Sodium Bicarbonate