Jd. Knottenbelt, TRAUMATIC RHABDOMYOLYSIS FROM SEVERE BEATING - EXPERIENCE OF VOLUME DIURESIS IN 200 PATIENTS, The journal of trauma, injury, infection, and critical care, 37(2), 1994, pp. 214-219
Fluid loading with balanced salt solution (BSS) was carried out in 200
patients with extensive soft tissue injuries from severe beatings. Ur
inary volume and dipstick specific gravity testing were used to monito
r renal function with administration of furosemide for persistent olig
uria. Acute intrinsic renal failure (AIRF) occurred in 21 patients (10
.5%) and five patients died (2.5%); two of hyperkalemia, two of sepsis
and one of multiple organ failure. Significantly increased rates of A
IRF and death were associated with injury-admission intervals of more
than 12 hours, severe metabolic acidosis, low initial hemoglobin, heav
y pigmenturia, and high serum creatine kinase (CK) levels. An increase
d serum creatinine/BUN ratio was noted in four of the five patients wh
o died. An average of 7.5 L fluids was needed in non-AIRF patients to
achieve adequate diuresis with a mean positive fluid balance of 4.7 L.
No patient without pigmenturia developed AIRF. Balance salt solution
volume diuresis supplemented with furosemide as necessary appears to b
e safe and effective in preventing AIRF in soft tissue injuries sustai
ned in beatings.