Acute renal failure in casualties of mass disasters

Human-made and seismic catastrophes continue to extract a heavy toll in lives. Many survivors with extensive muscle injury succumb to preventable causes such as shock, extreme hyperkalemia or acute renal failure (ARF). Others may lose limbs because of the compartment syndrome. Early treatment of such casualties, starting in the field, may increase salvage of lives and limbs, and prevent ARF. The treatment consists of aggressive volume and bicarbonate replacement followed by forced solute alkaline diuresis. If myoglobinuric ARF has occurred, solute load should not be given, and regular hemodialysis (HD) is indicated. If mass casualties have occurred in remote regions and HD cannot be immediately provided, continuous arteriovenous hemofiltration (CAVH) may temporarily substitute for HD. CAVH has the distinct advantage of simplicity, and does not require electricity, pumps or delivery systems. It is effective in eliminating potassium and relieving circulatory congestion without causing hypotension.