Clinical ScienceBicarbonate and mannitol treatment for traumatic rhabdomyolysis revisited

•The 2 major treatments for rhabdomyolysis are alkaline diuresis and crystalloid.•The use of a rhabdomyolysis protocol with mannitol and bicarbonate remains debated.•Use of a rhabdomyolysis protocol was supported for creatinine kinase greater than 10,000 U/L.•Evaluation of rhabdomyolysis strategies in a prospective randomized trial is needed.

BackgroundA rhabdomyolysis protocol (RP) with mannitol and bicarbonate to prevent acute renal dysfunction (ARD, creatinine >2.0 mg/dL) remains controversial.MethodsPatients with creatine kinase (CK) greater than 2,000 U/L over a 10-year period were identified. Shock, Injury Severity Score, massive transfusion, intravenous contrast exposure, and RP use were evaluated. RP was initiated for a CK greater than 10,000 U/L (first half of the study) or greater than 20,000 U/L (second half). Multivariable analyses were used to identify predictors of ARD and the independent effect of the RP.ResultsSeventy-seven patients were identified, 24 (31%) developed ARD, and 4 (5%) required hemodialysis. After controlling for other risk factors, peak CK greater than 10,000 U/L (odds ratio 8.6, P = .016) and failure to implement RP (odds ratio 5.7, P = .030) were independent predictors of ARD. Among patients with CK greater than 10,000, ARD developed in 26% of patients with the RP versus 70% without it (P = .008).ConclusionReduced ARD was noted with RP. A prospective controlled study is still warranted.