title: Bicarbonate and mannitol treatment for traumatic rhabdomyolysis revisited.
abstract: BACKGROUND
  A rhabdomyolysis protocol (RP) with mannitol and bicarbonate to prevent acute renal dysfunction (ARD, creatinine >2.0 mg/dL) remains controversial.
  
  
  METHODS
  Patients with creatine kinase (CK) greater than 2,000 U/L over a 10-year period were identified. Shock, Injury Severity Score, massive transfusion, intravenous contrast exposure, and RP use were evaluated. RP was initiated for a CK greater than 10,000 U/L (first half of the study) or greater than 20,000 U/L (second half). Multivariable analyses were used to identify predictors of ARD and the independent effect of the RP.
  
  
  RESULTS
  Seventy-seven patients were identified, 24 (31%) developed ARD, and 4 (5%) required hemodialysis. After controlling for other risk factors, peak CK greater than 10,000 U/L (odds ratio 8.6, P = .016) and failure to implement RP (odds ratio 5.7, P = .030) were independent predictors of ARD. Among patients with CK greater than 10,000, ARD developed in 26% of patients with the RP versus 70% without it (P = .008).
  
  
  CONCLUSIONS
  Reduced ARD was noted with RP. A prospective controlled study is still warranted.
authors.affiliation: Department of Surgery, Division of Trauma, Surgical Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Jamison S
authors.initials: JS
authors.lastname: Nielsen
authors.affiliation: Department of Surgery, Division of Trauma, Surgical Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR, USA; Surgical Critical Care Section, Veterans Administration Portland Healthcare System, Portland, OR, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Sally
authors.affiliation: Department of Surgery, Division of Trauma, Surgical Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Mullins
authors.affiliation: Department of Surgery, Division of Trauma, Surgical Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Slater
authors.affiliation: Surgical Critical Care Section, Veterans Administration Portland Healthcare System, Portland, OR, USA.
authors.forename: Tahnee
authors.initials: T
authors.lastname: Groat
authors.affiliation: Department of Surgery, Division of Trauma, Surgical Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Xiang
authors.initials: X
authors.lastname: Gao
authors.affiliation: Department of Surgery, Division of Trauma, Surgical Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR, USA.
authors.forename: J Salvador
authors.initials: JS
authors.lastname: de la Cruz
authors.affiliation: Department of Surgery, Division of Trauma, Surgical Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Margaret K M
authors.initials: MK
authors.lastname: Ellis
authors.affiliation: Department of Surgery, Division of Trauma, Surgical Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Schreiber
authors.affiliation: Department of Surgery, Division of Trauma, Surgical Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR, USA; Surgical Critical Care Section, Veterans Administration Portland Healthcare System, Portland, OR, USA. Electronic address: darren.malinoski@va.gov.
authors.forename: Darren J
authors.initials: DJ
authors.lastname: Malinoski
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000465:Algorithms; D001639:Bicarbonates / Q000627:therapeutic use*; D002985:Clinical Protocols; D003402:Creatine Kinase; D016208:Databases, Factual; D004234:Diuretics, Osmotic / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008353:Mannitol / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000150:complications*; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult
chemical_list: D001639:Bicarbonates; D004234:Diuretics, Osmotic; D008353:Mannitol; D003402:Creatine Kinase
keywords: Acute kidney injury; Alkaline diuresis; Creatine kinase; Mannitol; Rhabdomyolysis