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Preventing Renal Failure in Patients with Rhabdomyolysis: Do Bicarbonate and Mannitol Make a Difference?

Brown, Carlos V. R. MD; Rhee, Peter MD, MPH; Chan, Linda PhD; Evans, Kelly MS; Demetriades, Demetrios MD, PhD; Velmahos, George C. MD, PhD

Journal of Trauma-Injury Infection & Critical Care: June 2004 - Volume 56 - Issue 6 - pp 1191-1196
Original Articles

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.

From the Department of Surgery, Division of Trauma and Critical Care, University of Southern California and the Los Angeles County Medical Center, Los Angeles, California.

Submitted for publication September 24, 2003.

Accepted for publication February 28, 2004.

Poster presentation at the 62nd Annual Meeting of the American Association for the Surgery of Trauma, September 11–13, 2003, Minneapolis, Minnesota.

Address for reprints: Carlos V. R. Brown, MD, 1200 North State Street, Room 9900, Los Angeles, CA 90033; email: carlosbr@usc.edu.

© 2004 Lippincott Williams & Wilkins, Inc.