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Fluid Therapy in Pediatric Victims of the 2003 Bam, Iran Earthquake

Published online by Cambridge University Press:  28 June 2012

H. Sanadgol ,
I. Najafi ,
M. Rajabi Vahid ,
M. Hosseini  and
A. Ghafari
H. Sanadgol*
Affiliation:
Department of Nephrology, Zahedan Medical University, Zahedan, Iran Shafa CAPD Research Center, Tehran, Iran
I. Najafi
Affiliation:
Shafa CAPD Research Center, Tehran, Iran Department of Nephrology, Tehran University of Medical Sciences, Tehran, Iran
M. Rajabi Vahid
Affiliation:
Department of Nephrology, Zahedan Medical University, Zahedan, Iran
M. Hosseini
Affiliation:
Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
A. Ghafari
Affiliation:
Department of Nephrology, Urmia University of Medical Sciences, Urmia, Iran
*
Assistant Professor of Nephrology, Department of Internal Medicine, Khatam Al Anbia Hospital, Zahedan University of Medical Sciences, North Jame Jam Avenue, Zahedan 14114, Iran E-mail: sanadgol@yahoo.com
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Abstract

Introduction:

On 26 December 2003, at 05:26 hours, an earthquake of magnitude 6.6 (Richter scale) caused a disaster in the Bam region of Southeastern Iran, which had a population of approximately 102,000. In this study, the clinical and laboratory features and therapeutic interventions in pediatric (three months to 14 years) crush victims were analyzed. Determination of the type and amount of fluid therapy for prevention of acute renal failure (ARF) was the main aim of this study.

Methods:

The clinical and laboratory data and therapeutic interventions provided to 31 pediatric crush victims were collected. Early and vigorous fluid resuscitation was immediately performed. Resuscitation of the children from hypovolemic shock was initiated by interavenous (IV) administration of normal saline until the signs and symptoms of shock disappeared. For victims with crush injuries, an alkaline intravenous solution, up to 3 to 5 times more than maintenance doses was provided. In this study, there were two groups with decreasing severity of injury: (1) crush injury (CI), with or without ARF; and (2) non-crush injury (Non-CI). According to the above mentioned classification, there were 15 and 16 patients in group I and II, respectively.

Results:

The mean time spent under the rubble was 2.2 ±2.5 hours and 0.5 ±0.5 hours in Groups I and II, respectively. Seventy-five percent of ARF patients (n = 8), were admitted to the hospital the day of the earthquake (Day 0) and the day after earthquake (Day 1). In non-ARF patients (n = 7), 85.7% of the victims were admitted on Day 0 and Day 1. In Group II (ARF and non-ARF), all patients were admitted within three days after the earthquake. Although ARF did not develop in any of the children without CI, it was observed in eight of 15 patients with CI. There was no significant difference between CI with ARF (n = 8) and CI without ARF (n = 7) patients, in terms of the admission date, time of admission, hospitalization duration, and time under the rubble (TUR). Admission SGOTs were significantly different between these two groups. The ratio of the amount of delivered IV fluid (DL) to expected (EX) was based on weight of children was the only fluid therapy parameter in which there was a statistically significant difference between ARF and non-ARF groups. It was 3.6 ±0.99 in ARF and 4.8 ±0.74 in Nnon-ARF group (p = 0.01).

Conclusions:

Early intravenous volume replacement may prevent both ARF and dialysis need that may develop on the basis of rhabdomyolysis. In adults, six liters or 12–14 liters of fluids for prophylaxis of ARF in crush syndrome, were suggest-ed. In children, it seems that DL/EX ratio (delivered to expected ratio) is the best marker for evolution of IV fluid therapy in pediatric patients. In children with crush injuries, DL/EX ratio of >4.8 was sufficient for the prevention of ARF.

Keywords

acute renal failurecrush victimsearthquakefluid therapypediatric
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 24 , Issue 5 , October 2009 , pp. 448 - 452
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2009

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References

1.Hatamizadeh, P, Najafi, I, Vanholder, R, Sanadgol, H: Epidemiologic Aspects of Bam earthquake in Iran: The nephrology perspective. AJKD 2006;47(3):428–438.CrossRefGoogle Scholar
2.Report of Evaluation of places and people in the Affected Area of Bam Earthquake. Tehran, Iran Library of the Statistical center of Iran, Publication number 20015, 2004Google Scholar
3.Better, OS, Stein, JH: Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis. N Engl J Med 1990;322:825–829.Google ScholarPubMed
4.Atef, MR, Nadjatfi, I, Boroumand, B, Rastegar, A: Acute renal failure in earth-quake victims in Iran: Epidemiology and management. Q J Med 1994;87:35–40.Google Scholar
5.Slater, MS, Mullins, RJ: Rhabdomyolysis and myoglobinuric renal failure in trauma and surgical patients: A review. J Am Coll Surg 1998;186:693–716.CrossRefGoogle ScholarPubMed
6.Demikiran, O, Dikmen, Y, Utku, T, Urkmez, S: Crush syndrome patients after the Marmara earthquake. Emerg Med J 2003;20:247–250.CrossRefGoogle Scholar
7.Malinoski, DJ, Slater, MS, Mullins, RJ: Crush injury and rhabdomyolysis. Crit Care Clin 2004;20(1):171–192.CrossRefGoogle ScholarPubMed
8.Eknoyan, G: Acute renal failure in the Armenian earthquake. Ren Fail 1992;14:241–244.CrossRefGoogle ScholarPubMed
9.Oda, Y, Shindoh, M, Yukioka, H, et al. : Crush syndrome sustained in the 1995 Kobe, Japan, earthquake: Treatment and outcome. Ann Emerg Med 1997;30:507–512.CrossRefGoogle ScholarPubMed
10.Tanaka, H, Oda, J, Iwai, A, et al. : Morbidity and mortality of hospitalized patients after the 1995 Hanshin-Awaji earthquake. Am J Emerg Med 1999;17:186–191.CrossRefGoogle ScholarPubMed
11.Iskit, SH, Alpay, H, Tugtepe, H, et al. : Analysis of 33 pediatric trauma victims in the 1999 Marmara, Turkey Earthquake. Journal of Pediatric Surgery 2001;36,(2):368–372.CrossRefGoogle ScholarPubMed
12.Guha-Sapir, D, Carballo, M: Disaster in Turkey: Lessons for health pre-paredness. Lancet 1999;354:1649.CrossRefGoogle Scholar
13.Oda, J, Tanaka, H, Yoshioka, T, et al. : Analysis of 372 patients with crush syn-drome casued by the Hanshin-Awaji earthquake. J Trauma 1997;42:470–475.CrossRefGoogle Scholar
14.Better, OS, Stein, JH: Early manegment of shock and prophylaxis of acute renal failure in traumatic rubdomyolysis. N Engl J Med 1990;322:825–829.Google Scholar
15.Gunal, AI, Celiker, H, Dogukan, A, et al. : Early and vigorous fluid Resuscitation prevents Acute Renal failure in the crush victims of cata-strophic earthquakes. Am Soc Nephrol 2004;15:1862–1867.CrossRefGoogle Scholar