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NDT Advance Access published online on March 22, 2005
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh779
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received October 8, 2004
Accepted February 9, 2005

Preliminary Communication

Oral alkalinizing solution as a potential prophylaxis against myoglobinuric acute renal failure: preliminary data from healthy volunteers

Ramin Tolouian 1*, Dorothea Wild 1, Mohammad H. Lashkari 2, and Iraj Najafi 3

1 Griffin Hospital, Yale University School of Medicine, Derby, CT, USA
2 Army University of Medical Sciences, Tehran, Iran
3 Tehran University of Medical Sciences, Tehran, Iran

* To whom correspondence should be addressed.
Ramin Tolouian, E-mail: tolouian{at}usc.edu



  Abstract

Background. Acute renal failure (ARF) secondary to crush injury is one of the leading causes of hospitalization and death in survivors of massive disasters. The standard therapy for crush injury, intravenous (i.v.) hydration and alkalinization of urine, is often not feasible after a mass disaster; therefore, oral rehydration and urinary alkalinization may be a useful substitute.

Methods. We developed and evaluated an oral alkalinizing solution (OAS) to induce alkaline diuresis. We enrolled 12 volunteer Iranian Army recruits (mean age 19.4±0.8 years) who drank an average of 650 ml of OAS for 12 h. We checked the volume and pH of their urine every hour, and measured venous blood gas and electrolytes at 6, 12 and 15 h.

Results. All subjects tolerated the OAS without adverse events, and had active diuresis (>200 ml/h) after an average of 3.0±0.7 h. Their urine became alkaline (pH>7.0) within an average of 3.25±0.8 h. There were no significant electrolyte abnormalities.

Conclusions. OAS seems to be a safe and promising means of inducing alkaline diuresis. It may be a feasible alternative to i.v. hydration to prevent ARF secondary to crush injuries in the context of mass disasters where i.v. hydration is not possible. A dose of 10 ml/kg/h may be the correct amount to induce alkaline diuresis within the first 12 h after crush injuries. The use of OAS for this purpose should be evaluated further.

Keywords: crush injury; oral solution; earthquake rhabdomyolysis.
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