The crush syndrome Invited Editor

Year 2009, Volume: 44 Issue: 2, 43 - 47, 01.06.2009

Lale Sever

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 Key words: Children crush syndrome earthquake

Keywords

-

Ezilme sendromu Çağrılı Editör

Abstract

Ezilme sendromu travmaya bağlı rabdomiyoliz sonucunda ortaya çıkan ve pek çok dahili ve cerrahi komplikasyona yol açan sistemik bir hastalıktır Ezilme sendromuna bağlı akut böbrek yetersizliğinin ABY patojenezi iki başlık altında incelenebilir: 1 Rabdomiyoliz ve 2 Rabdomiyoliz zemininde ortaya çıkan ABY Kasların basıya uğraması baromiyopati rabdomiyolize neden olur Rabdomiyoliz terimi çizgili kas hücresinin bütünlüğünün bozulup içindeki maddelerin dolaşıma geçmesini ifade eder Öte yandan sodyum klorür ve su da kas hücresi içine girer ve hücre şişmesi kompartman sendromu ortaya çıkar Rabdomyoliz zemininde ABY nin gelişiminde çeşitli etmenlerin etkisi vardır Bunlar içinde en önemlisi kompartman sendromunun yol açtığı hipovolemi nedeniyle böbrek perfüzyonunun bozulmasıdır Kas travması olan tüm olgularda ezilme sendromu ve ABY ortaya çıkmaz Bu sendrom çocuklarda daha da nadirdir Rabdomiyolizin en önemli belirteci serum kreatin fosfokinaz düzeyinin yükselmesidir Öte yandan en hayati laboratuvar bulgusu hiperkalemidir Tıbbi girişimler açısından ABY’nin önlenmesi çok önemlidir Bu amaçla hastalara uygun sıvı desteğinin yapılması gerekir Akut böbrek yetersizliği olan ezilme sendromlu hastalarda en etkili tedavi seçeneği hemodiyalizdir Türk Ped Arş 2009; 44: 43 7 Anahtar kelimeler: Çocuklar deprem ezilme sendromu

Keywords

Çocuklar, deprem, ezilme sendromu

References

• Zager RA. Rhabdomyolysis and myohemoglobinuric acute re- nal failure. Kidney Int 1996; 49: 314-26. 2. Sever MS. The Crush Syndrome and lessons learned from the Marmara Earthquake. 1st ed. Basel: Karger AG, 2005: 58-75.
• Better OS, Abassi Z, Rubinstein I, Marom S, Winawer Y, Silber- man M. The mechanism of muscle injury in the crush syndro- me: Ischemic versus pressure-stretch myopathy. Miner Elec- trolyte Metab 1990; 16: 181-4.
• Michaelson M. Crush injury and crush syndrome. World J Surg 1992; 16: 899-903.
• Oda J, Tanaka H, Yoshioka T, et al. Analysis of 372 patients with crush syndrome caused by the Hanshin-Awaji earthquake. J Trauma 1997; 42: 470-6.
• Sever MS, Erek E, Vanholder R, et al. Lessons learned from the Marmara Disaster: Time period under the rubble. Crit Care Med 2002; 30: 2443-9.
• Better OS, Stein JH. Early management of shock and prophyla- xis of acute renal failure in traumatic rhabdomyolysis. N Eng J Med 1990; 322: 825-9.
• Owen CA, Mubarak SJ, Hargens AR, Rutherford L, Garetto LP; Akeson WH. Intramuscular pressures with limb compression: clarification of the pathogenesis of the drug-induced muscle- compartment syndrome. N Eng J Med 1979; 300: 1169-72.
• Rubinstein I, Abassi Z, Coleman R; Milman F, Winawer J, Bet- ter OS. Involvement of nitric oxide system in experimental muscle crush injury. J Clin Invest 1998; 101: 1325-33.
• Harris K, Walker PM, Mickle DA, et al. Metabolic response of skletal muscle to ischemia. Am. J Physiol 1986; 250: H213-20.
• Slater MS, Mullins RJ. Rhabdomyolisis and myoglobinuric renal failure in trauma and surgical patients: A review. J Am Coll Surg 1998; 186: 693-716.
• Sever MS, Erek E, Vanholder R, et al. The Marmara Earthqua- ke- Epidemiological analysis of the victims with nephrological problems. Kidney Int 2001; 60: 1114-23.
• Donmez O, Meral A, Yavuz M, Durmaz O. Crush syndrome of children in the Marmara Earthquake, Turkey. Pediatr Int 2001; 43: 678-82.
• Iskit SH, Alpay H, Tugtepe H, et al. Analysis of 33 pediatric trau- ma victims in the 1999 Marmara, Turkey earthquake. J Pediatr Surg 2001; 36: 368-72.
• Sever MS, Erek E, Vanholder R, et al. Serum potassium in the crush victims of the Marmara disaster. Clin Nephrol 2003; 59: 326-33.
• Sever MS, Vanholder R, Lameire N. Management of crush-re- lated injuries after disasters. N Eng J Med 2006; 354: 1052-63.
• Gunal AI, Celiker H, Dogukan A, et al. Early and vigorous fluid re- suscitation prevents acute renal failure in the crush victims of ca- tastrophic earthquakes. J Am Soc Nephrol 2004; 15: 1852-67.
• Erek E, Sever MS, Serdengeçti K, et al. An overview of morbi- dity and mortality in the patients with acute renal failure due to crush syndrome. Nephrol Dial Transplant 2002; 17: 33-40.