What is the risk of crush injury and rhabdomyolysis, and how is it prevented?

• A. Rhabdomyolysis with potential acute kidney injury; prevent with aggressive IV fluids, urine output monitoring, and consider urine alkalinization in select cases
• B. Rhabdomyolysis has no kidney risk; prevent with rest
• C. No risk; treat with analgesics
• D. Kidney stones risk

Answer: (A)

Crush injuries can trigger muscle breakdown (rhabdomyolysis), releasing myoglobin into the bloodstream. Myoglobin can travel to the kidneys and cause pigment-related obstruction and direct tubular injury, increasing the risk of acute kidney injury, especially if perfusion is poor or electrolytes are imbalanced.

Prevention centers on early, aggressive fluid resuscitation with isotonic IV fluids to preserve renal perfusion and dilute myoglobin, along with close urine output monitoring to ensure the kidneys are being adequately perfused (typical targets are a substantial urine output, adjusted for body weight). In select cases, such as when there’s persistent rhabdomyolysis risk or documented myoglobin-induced injury, urine alkalinization with bicarbonate may be used to reduce myoglobin precipitation in the tubules.

Rest or analgesics alone do not prevent kidney injury from rhabdomyolysis, and the notion of no kidney risk or only kidney stones does not fit the pathophysiology.