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

Brown, Carlos; Rhee, Peter; Chan, Linda S.; Evans, Kelly; Δημητριάδης, Δημήτριος; Velmahos, George C.

doi:10.1097/01.ta.0000130761.78627.10

Cited by 316 publications

(219 citation statements)

References 16 publications

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“…42 Unfortunately, the use of sodium bicarbonate has not been shown to decrease the incidence of AKI or mortality in rhabdomyolsis. 43 Even though questions also remain about its efficacy, mannitol was selected for this patient due to its ability to increase renal blood flow and maintain renal filtration fraction and oxygenation. 43,44 Veno-venous extracorporeal membrane oxygenation was considered briefly on POD 3 due to profound hypoxemia and refractory hypercarbia but ultimately was not necessary, given the rapid improvement in his respiratory status after diuresis was initiated.…”

Section: Postoperative Intensive Care Managementmentioning

confidence: 99%

“…43 Even though questions also remain about its efficacy, mannitol was selected for this patient due to its ability to increase renal blood flow and maintain renal filtration fraction and oxygenation. 43,44 Veno-venous extracorporeal membrane oxygenation was considered briefly on POD 3 due to profound hypoxemia and refractory hypercarbia but ultimately was not necessary, given the rapid improvement in his respiratory status after diuresis was initiated. Fortunately, his rhabdomyolysis and renal failure resolved, allowing for rapid ventilator weaning, successful extubation, and subsequent recovery.…”

Section: Postoperative Intensive Care Managementmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative Management of Adrenalectomy and Inferior Vena Cava Reconstruction in a Patient With a Large, Malignant Pheochromocytoma With Vena Caval Extension

Gregory

Yalamuri

McCartney

et al. 2017

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Postoperative Intensive Care Managementmentioning

confidence: 99%

Section: Postoperative Intensive Care Managementmentioning

confidence: 99%

Perioperative Management of Adrenalectomy and Inferior Vena Cava Reconstruction in a Patient With a Large, Malignant Pheochromocytoma With Vena Caval Extension

Gregory

Yalamuri

McCartney

et al. 2017

Journal of Cardiothoracic and Vascular Anesthesia

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“…Retrospective cohort analyses suggested that intravenous sodium bicarbonate was associated with an increased risk of CIN [43] or pigment nephropathy [44,45]. The multicenter trial of prophylactic perioperative sodium bicarbonate administration to prevent AKI following open heart surgery found a non-significant increase in AKI and a possible increase in in-hospital mortality [37].…”

Section: Prevention Of Aki By Sodium Bicarbonate Infusion: Harmsmentioning

confidence: 99%

Sodium bicarbonate infusion for prevention of acute kidney injury: No evidence for superior benefit, but risk for harm?

Schiffl

2014

Int Urol Nephrol

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“…Despite these theoretical benefits, the use of sodium bicarbonate does not appear to prevent renal failure, the need for dialysis, or mortality in patients with rhabdomyolysis [61]. Similarly, the use of mannitol or loop diuretics to increase urinary flow offers the theoretical benefit of decreasing the concentration of myoglobin in the renal tubules, however, clinical studies have failed to show benefit from their administration [60,61].…”

Section: What Treatments Should Be Undertaken In a Patient With Rhabdmentioning

confidence: 99%

Case Files of the Medical Toxicology Fellowship at Drexel University

Vearrier

Curtis

2011

J. Med. Toxicol.

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A 28-year-old female was brought to the emergency department (ED) by her roommate after a suicide attempt, in which the patient took 29 capsules of an over-the-counter (OTC) sleep aid containing 50 mg of diphenhydramine (DPH) per capsule, for a total of 1450 mg, and consumed 100 ml of vodka. Her weight was 67 kg, yielding a dose of 22 mg/kg DPH. When a roommate arrived home from work several hours later, he noticed that the patient was walking aimlessly through the house and that "she was out of it." The patient subsequently informed the roommate of her suicide attempt, at which point he brought her by car to our ED. According to the patient, the ingestion occurred 9 h prior to arrival.In the ED, the patient complained of bilateral tingling and numbness in her legs and feet that had started within the last 4 h. She had a subjective sensation of inability to control the muscles in her legs and leg weakness. The patient denied any history of leg trauma, recent strenuous physical activity, or recent prolonged inactivity. Her medical history was significant for cervical dysplasia status post surgical excision and major depressive disorder. The patient denied taking any other prescribed or OTC medications, which her roommate corroborated.Physical examination revealed a young, disheveled female with normal body habitus. Initial vital signs included a temperature of 36.4°C, heart rate 123 beats/ min, respiratory rate 18 breaths/min, blood pressure 112/ 83 mm Hg, and pulse oximetry of 98% on room air. Pupils were 6 mm bilaterally and sluggishly reactive to light. Extraocular movements were intact. The mucous membranes of the oropharynx were dry. Cardiac examination was significant for a regular tachycardia, while the pulmonary examination was normal. Abdominal examination was significant for bowel sounds being present but decreased. The patient was alert and oriented to self and place, but not to time. She was able to answer simple questions, but was slow to respond. Strength, sensation, and deep tendon reflexes were normal. No ataxia or tremor was present. Extremity examination was significant for mottled skin color on the anterior legs bilaterally. Dorsalis pedis and posterior tibialis pulses were normal, as was sensation, strength, and capillary refill throughout the bilateral lower extremities. What is the Pharmacology of DPH?DPH is a first-generation H 1 antihistamine. It belongs to the ethanolamine subclass of antihistamines along with carbinoxamine, clemastine, dimenhydrinate, and doxylamine. Histamine receptors are categorized into four subtypes This case report was presented in poster form at the EAPCCT conference in 2009 in Stockholm, Sweden.

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

Cited by 316 publications

References 16 publications

Perioperative Management of Adrenalectomy and Inferior Vena Cava Reconstruction in a Patient With a Large, Malignant Pheochromocytoma With Vena Caval Extension

Perioperative Management of Adrenalectomy and Inferior Vena Cava Reconstruction in a Patient With a Large, Malignant Pheochromocytoma With Vena Caval Extension

Sodium bicarbonate infusion for prevention of acute kidney injury: No evidence for superior benefit, but risk for harm?

Case Files of the Medical Toxicology Fellowship at Drexel University

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