Just about the only thing everyone agrees on in the prevention of pigment induced renal failure is early aggressive volume resuscitation (don't just order half a liter saline bolus and call it a day).
Urinary alkalinization with bicarb and the use of mannitol have been advocated as “specific” measures for this syndrome but remain controversial. The Renal Fellow Network recently updated this topic. The controversy stems from inconclusive evidence (alkalinization and mannitol may benefit some patients, e.g. crush syndrome victims, more than others, and different populations were studied in different studies that showed varying outcomes) and possible harm (hypocalcemia from alkalinization and osmotic nephrosis from injudicious use of mannitol .
Go read the whole thing and check out the links.
No comments:
Post a Comment