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      Response to Delayed Fluid Therapy in Crush Syndrome

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          Abstract

          Background: Although early treatment is valuable in the prognosis of crush syndrome, the diagnosis and treatment of many victims are inevitably delayed in major disasters. Patients and Methods: Among the 38 victims of the Marmara earthquake with crush injury, 27 were diagnosed as crush syndrome on the basis of findings of acute renal failure. Intensive intravenous fluid treatment was started in all patients on admission. Of these 27 patients, 10 required dialysis treatment while 17 did not. The laboratory data on admission were evaluated and compared between the two groups. Results: The mean admission time of 27 patients was 46.5 ± (SE) 3.08 h. There was no significant difference between the dialysis and the nondialysis groups with regard to patient’s age, trapped time or admission time. A significantly higher number of patients had crush injury in more than one extremity in the dialysis group. The dialysis group had significantly lower systolic blood pressure, central venous pressure but a higher heart rate together with higher levels of serum urea nitrogen, creatinine, creatinine kinase, C-reactive protein, fibrinogen on admission compared to the nondialysis group. Conclusion: Our results suggest that even delayed application of aggressive specific fluid treatment under close monitoring may prevent the development of established acute renal failure.

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          Most cited references 2

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          Prevention of acute renal failure in traumatic rhabdomyolysis.

          Following the collapse of a building, seven subjects (aged 18 to 41 years) were released from under the rubble within one to 28 hours. All seven suffered from extensive crush injuries with evidence of severe rhabdomyolysis and were treated by the induction of an alkaline solute diuresis immediately on their extrication from the debris. The leakage of muscle constitutents was estimated by quantifying the net total body potassium losses, which averaged 395 mEq (SD, +/- 198) over the first 60 hours of therapy. In the past, injuries of similar severity have been associated with a high incidence of acute renal failure and a high mortality rate, yet none of our patients had azotemia or renal failure. We attribute this success to the unprecedented early institution of appropriate therapy.
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            Analysis of 33 pediatric trauma victims in the 1999 Marmara, Turkey earthquake.

            The Marmara earthquake, which destroyed more than 150,000 buildings and caused 15,000 deaths and 40,000 casualties, resembled the Hanshin-Awaji earthquake in many respects. Previous reports from similar disasters from several centres have not addressed trauma in the pediatric age group. The aim of this study was to analyze the clinical and laboratory data of pediatric trauma patients referred to a tertiary center after the 1999 Marmara earthquake. The medical records of 33 injured children, aged from 14 days to 16 years, were reviewed retrospectively. The time spent buried under rubble, type of injury, treatment given, complications, laboratory data, and development of acute renal failure (ARF) were noted. Patients in whom ARF developed were treated with a standard regimen of fluid replacement, alkalinization, and diuretics. Limbs with crush injuries were managed as conservatively as possible. All except 3 cases were evacuated from under the debris of collapsed buildings after 1 to 110 (mean, 30.04 +/- 6.48) hours. Seventy-eight percent were transported to our center within the first 3 days. Crush injury (CI) was present in 15 cases, and in 10 of them ARF had already developed by admission. Although serum levels of creatinine were elevated (1.2 to 5 mg/dL) in all cases with ARF, hyperkalemia was observed in only 4. The mean serum creatinine kinase (CK) level of cases with crush syndrome (CS) was 6,040 +/- 4,158 U/L. No significant correlations were detected between the development of CS, age, the time spent under the rubble, the time before admission, or the number of crushed extremities. CI and CS were the most common entities encountered among our pediatric patients after the 1999 Marmara earthquake. The high incidence of ARF indicates the importance of medical management of this age group during rescue. Because neither laboratory data nor clinical findings predicted CS in our patients, we recommend close observation and monitoring of children with CI for the development of ARF.
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              Author and article information

              Journal
              NEF
              Nephron
              10.1159/issn.1660-8151
              Nephron
              S. Karger AG
              1660-8151
              2235-3186
              2002
              October 2002
              18 October 2002
              : 92
              : 4
              : 941-943
              Affiliations
              aNephrology and Dialysis Unit; Departments of bCardiology, cAnesthesiology, and dTraumatology, Emergency Hospital, Ankara, Turkey
              Article
              65453 Nephron 2002;92:941–943
              10.1159/000065453
              12399646
              © 2002 S. Karger AG, Basel

              Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

              Page count
              Figures: 1, Tables: 1, References: 12, Pages: 3
              Product
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/65453
              Categories
              Short Communication

              Cardiovascular Medicine, Nephrology

              Acute renal failure, Fluid therapy, Dialysis, Crush syndrome

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