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Forum Newbie
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Last Login: 6/26/2009 4:18:41 PM
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Has anyone had the experience of having a young donor crash after hours of intense fluid and electrolyte replacement? Have you ever had a donor with a potassium of barely 1 for hours and then then after hours, it is 6 and the patient crashes? Every donor we have has the potential of developing Rhabdomyolysis. Don't forget to check CPK levels in non-cardiac donors. Any level over 5000 needs to be treated, although this value will vary depending on which article you read. These patients develop renal failure and are very hard to manage so don't forget to keep an eye on CPKs!
I would lover to hear comments on your experience with donors in rhabdo!
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Forum Member
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Last Login: 4/9/2011 7:51:09 PM
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| Susan, You bring up a valid point. I don't normally check CPK's on non-cardiac donors. We have had a few cases in which the donor was in rhabdomyolysis. From memory, these were patients with either crush injuries or significant down time. Adequate hydration and alkalinizing the urine does help. Several years ago, while on a travel assignment in AZ, I evaluated several pt's in rhabdo. Of course it was in July (well above 100 degrees), and the prevalence of methamphetamines is much higher than here in New England. One reminder is that there have been several reports of using these kidneys for transplantation. Dr Kumar (Drexel) published his results in Transplantation 2006;82:1640-1645
John E Belcher BS, CCEMT-P, CPTC, CTBS
Donation CoordinatorNew England Organ Bank
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Last Login: 3/18/2011 10:36:46 AM
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| Great Point! I am sure this something I was not doing on a regular basis. I will be sure to share this amongst out coordinators. I have only has one pt who had rhabdo while in the hospital, but prior to the incident which caused brain death and had pretty much resolved itself, although the kidneys did take a hard hit!
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Forum Newbie
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| Susan, very interesting point. Where I work, we do monitor CPK's routinely in all donors. It is very useful in watching for rhabdo and can be treated appropriately to save kidney function.
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Last Login: 3/31/2009 2:32:28 PM
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| Good Point.. I have not been checking CPK's on all donors but it makes sense to start doing so.
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Forum Newbie
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| Great point regarding CPK monitoring in all donors. Frankly, can't say that I came across this issue a lot. The number of donors from traumatic injuries have been steadily declining for us. Any special way to treat rhabdomyolysis in brain dead patients? How about if donor is in massive DI? Would you come off vasopressin first (abnormal electrolytes, volume depletion) or would you prefer adding diuretics besides the vasopressin?
- Laszlo Kalmar, RN
- Organ Donation Specialist
- BC Transplant
- Vancouver, BC
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| I don't think there is anything in the literature to guide the treatment of rhabdomyolysis in this population. It is reasonable to support these patients as any other critically ill patient. Most of the literature will suggest aggressive volume resuscitation (~1000 cc/hour) and to continue this until there is no longer any evidence of myoglubinuria. Some have advocated for both bicarb and mannitol. Bicarbonate is thought to help prevent the conversion of hemoglobin to methemoglubin. Mannitol has shown (small studies) to reduce the incidence of renal failure. Reference: Brown et al, Preventing renal failure in patients with rhabdolyolysis: do bicarbonate and mannitol make a difference? J Trauma 2004; 56(6):1191-1196
John E Belcher BS, CCEMT-P, CPTC, CTBS
Donation CoordinatorNew England Organ Bank
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We test potential cardiac donors and those we think amy be at wrisk for rhabdo: crush/ blunt injury, long time (e.g. laying on floor)before found, or any other mechanism that makes us think lots of cell lysis might have occured.
Adam Bell, CCEMT-P, CPTC
LifeBanc, Cleveland, Ohio, USA
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