Management of earthquake-related acute renal injury

Table 1 Crush syndrome incidence as reported by different studies on earthquake injuries

Ref.	Earthquake	Country	Year	Severity Richter scale	Crush syndrome
Phalkey et al[12]	Gujarat	India	2001	7.9	5.8%
Dai et al[13]	Wenchuan	China	2008	8	9.3%
Yang et al[14]	Wenchuan	China	2008	8	3.9%
Min et al[15]	Wenchuan	China	2008	8	2.9%
Min et al[15]	Yushu	China	2010	7.1	2.4%
Bar-On et al[16]	Haiti	Haiti	2010	7	1.2%
Guner et al[17]	Van	Turkey	2011	7.2 and 5.7 (twin)	1.2%
Giri et al[18]	Nepal	Nepal	2015	7.8 and 7.3 (twin)	3%
Özdemir et al[19]	Kahramanmaras	Turkey	2023	7.8 and 7.6 (twin)	16.4%

Table 2 Checklist for the management of acute crush syndrome

Investigations
Blood tests: Complete blood count, arterial blood gas, creatinine phosphokinase, comprehensive metabolic panel
Coagulation profile: Prothrombin time, activated partial thromboplastin time, international normalized ratio, fibrinogen
Urine tests: Dipstick and urine sediments
The 12-lead electrocardiogram to assess findings for hyperkalemia or hypocalcemia
Management
Start aggressive intravenous fluids to maintain a urine output of around 200-300 mL/hour
Monitor potassium every 4 hours and manage hyperkalemia aggressively
Correct hypocalcemia only when symptomatic (tetany or seizures)
Consult a nephrologist when dialysis is indicated including volume overload, hyperkalemia, severe acidemia, and uremia

Table 3 Indications for renal replacement therapy

Indications
Serum potassium concentration > 6.5 mmol/L or its rapid rise
Pondus hydrogenii ≤ 7.1 (severe acidosis)
Blood urea nitrogen concentration > 30 mmol/L
Serum creatinine concentration > 700 μmol/L
Uremic symptoms (hypervolemia, encephalopathy, and pericarditis)
Continued oliguria (200 mL/12 hours) or anuria (50 mL/12 hours) despite adequate fluid resuscitation