The crush syndrome

Abstract

Crush syndrome is a systemic disorder resulting from trauma-associated rhabdomyolysis that causes several medical and surgical complications. Pathogenesis of crush syndrome-related acute renal failure (ARF) can be studied under two headings: 1) Rhabdomyolysis, and 2) ARF on the basis of rhabdomyolysis. Compression of the muscles (baromyopathy) induces rhabdomyolysis. The term rhabdomyolysis points out to the disintegration of striated muscles, which results in the release of muscular cell contents into the circulation. On the other hand sodium, chloride, water and calcium diffuse into the muscle cell, and cellular swelling, "compartment syndrome", occurs. Various factors contribute to the development of ARF on the basis of rhabdomyolysis. Among these the most important one is impairment of renal perfusion as a result of hypovolemia due to compartment syndrome. The crush syndrome and ARF do not necessarily develop in all cases who suffer from muscle trauma. This syndrome is observed relatively rarely in children. The most useful indicator of rhabdomyolysis is an increase in serum creatine phosphokinase level. On the other hand the most critical laboratory abnormality is hyperkalemia. Considering the medical interventions, prophylaxis of ARF is vital. Fluid replacement is the most important measure for this goal and intermittent hemodialysis is the most effective modality for the treatment of the crush patients with ARF. (Turk Arch Ped 2009; 44: 43-7)