Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference?

Abstract

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.

CONCLUSION:

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.

• Authors: Carlos V R Brown, Peter Rhee, Linda Chan, Kelly Evans, Demetrios Demetriades, George C Velmahos
• Journal: The Journal of trauma (J Trauma) Vol. 56 Issue 6 Pg. 1191-6 (Jun 2004) ISSN: 0022-5282 [Print] United States
• PMID: 15211124 (Publication Type: Journal Article)

Chemical References

• Diuretics, Osmotic
• Mannitol
• Sodium Bicarbonate
• Creatine Kinase

Topics

• Acute Kidney Injury (blood, etiology, prevention & control)
• Creatine Kinase (blood)
• Diuretics, Osmotic (administration & dosage, therapeutic use)
• Drug Therapy, Combination
• Female
• Humans
• Logistic Models
• Male
• Mannitol (administration & dosage, therapeutic use)
• Middle Aged
• Odds Ratio
• Rhabdomyolysis (blood, complications)
• Risk Factors
• Sodium Bicarbonate (administration & dosage, therapeutic use)