Renal failure

• Renal failure is thought to be produced by a combination of free radical injury, hypovolaemia, hypotension and, possibly, myoglobin blocking the renal tubules.

• Renal failure may be prevented by prompt rehydration and a forced alkaline diuresis with 6-10l 0.9% saline/day for 3-5 days, aiming to produce an equivalent amount of urine. The urinary pH should be maintained >6 and blood pH <7.5 using up to 500ml/h 1.24% sodium bicarbonate solution to increase urinary excretion of myoglobin. Furosemide and/or mannitol may be needed to avoid fluid overload and potassium, sodium, calcium and magnesium levels regularly monitored and managed as appropriate.

• If renal failure is established, dialysis or filtration techniques will be required, usually for a period of 6-8 weeks.


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