Pigment-induced nephropathy after sjambok injuries

During a 12-month period, 42 patients required admission to hospital after sjambok beatings. Eighteen showed no abnormality of serum electrolyte values or renal function but urinary pigment precipitation was present in 9 patients. A further 16 patients demonstrated abnormalities of serum urea and electrolyte values, the commonest of which was a subnormal venous carbon dioxide content, in conjunction with urinary pigment precipitation in 14 cases. The remaining 8 patients presented with, or developed, varying degrees of renal failure. In 4 of these patients, the sole initial biochemical abnormality was a subnormal venous carbon dioxide level. Based on the initial laboratory findings, four groups of patients may be identified with gradations of soft-tissue injury. Recognition of those patients at risk of developing crush syndrome is facilitated and appropriate treatment may be instituted at an early stage thereby reducing morbidity and mortality.