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Hyponatraemia in patients with crush syndrome during the Wenchuan earthquake
  1. Li Zhang1,
  2. Ping Fu2,
  3. Li Wang3,
  4. Guangyan Cai1,
  5. Lin Zhang4,
  6. Dezheng Chen5,
  7. Dongyang Guo6,
  8. Xuefeng Sun1,
  9. Fuqiong Chen7,
  10. Weihong Bi8,
  11. Xinjie Zeng9,
  12. Haiyan Li10,
  13. Zhaohui Liu11,
  14. Yong Wang1,
  15. Songmin Huang2,
  16. Xiangmei Chen1,
  17. for the Wenchuan earthquake-related AKI study group
  1. 1State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, Beijing, China
  2. 2Department of Nephrology, Huaxi Hospital, Sichuan University, Chengdu, China
  3. 3Department of Nephrology, Sichuan People's Hospital, Chengdu, China
  4. 4Department of Nephrology, Mianyang Central Hospital, Mianyang, China
  5. 5Department of Nephrology, Jianyang People's Hospital, Jianyang, China
  6. 6Department of Nephrology, General Hospital of Chengdu Military Region, Chengdu, China
  7. 7Department of Nephrology, 404 Hospital of Mianyang, Mianyang, China
  8. 8Department of Nephrology, Third People's Hospital of Mianyang City, Mianyang, China
  9. 9Department of Nephrology, Guangyuan City Central Hospital, Guangyuan, China
  10. 10Department of Nephrology, Deyang City People's Hospital, Deyang, China
  11. 11Department of Nephrology, The Second Hospital in Chengdu, Chengdu, China
  1. Correspondence to Professor Xiangmei Chen, State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, 2011DAV00088, 28 Fuxing Road, Beijing 100853, People's Republic of China; xmchen301{at}126.com

Abstract

Background Although sodium disturbances are common in hospitalised patients, no study has specifically investigated the epidemiology of hyponatraemia in patients with crush syndrome.

Objectives To describe the incidence of hyponatraemia and assess its effect on outcome in patients with crush syndrome during the Wenchuan earthquake.

Methods A retrospective study was conducted in 17 reference hospitals during the Wenchuan earthquake. We excluded patients younger than 15 years and those with missing sodium values within 3 days after being rescued from the ruins.

Results Hyponatraemia (serum sodium concentration <135 mmol/l) was seen in 91/180 (50.6%) patients on admission. Compared with patients with normonatraemia, those with hyponatraemia were younger, had more severe traumatic injury and renal failure, underwent more fasciotomies, received more blood transfusion and renal replacement therapy. In the multivariable-adjusted model, the number of extremity injuries (OR=1.59, 95% CI 1.08 to 2.33) and serum creatinine (OR=1.30, 95% CI 1.07 to 1.59) were independently associated with the occurrence of hyponatraemia. Covariate adjusted multiple logistic regression analysis showed an independent mortality risk rising with hyponatraemia (OR=5.74, 95% CI 1.18 to 28.00).

Conclusions Hyponatraemia was common in the patients with crush syndrome during the Wenchuan earthquake and associated with poor prognosis. Water, commercial drinks and hypotonic intravenous fluids should be supplied carefully to patients with crush syndrome.

  • Trauma
  • intensive care
  • renal
  • prehospital care
  • emergency care systems, primary care

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

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