FLUID RESUSCITATION AND SYSTEMIC COMPLICATIONS IN CRUSH-SYNDROME - 14HANSHIN-AWAJI-EARTHQUAKE PATIENTS

Background: Crush syndrome is a form of traumatic rhabdomyolysis chara cterized by systemic involvement, in which acute renal failure is pote ntially life-threatening. Methods: Clinical and laboratory data of 14 crush-syndrome patients transferred to a tertiary emergency department after the Hanshin-Awaji earthquake were analyzed, The patients were b uried under collapsed houses for the average of 6.7 +/- 5.7 (SD) hours (range, 1 to 24 hours), They were referred to us 6 to 250 hours after the earthquake, Results: Of those who arrived at our institution with in 40 hours, 25% (two of eight) developed renal failure, whereas all s ix patients who arrived after 30 hours developed renal failure, Peak s erum creatine kinase ranged from 6,677 to 134,200 U/L (51,674 +/- 41,7 76), Renal failure was highly associated with massive muscle damage (s erum creatine kinase above 25,000 U/L) and insufficient initial fluid resuscitation (below 10,000 mL/2 days), Conclusions: Prompt and adequa te, if not massive, fluid resuscitation is the key to preventing renal failure after such injury.