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[A very old man with Crush syndrome]
1Second Department of Internal Medicine, Ehime University School of Medicine.
Nihon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
|October 1, 1996
Summary
A 90-year-old man with crush syndrome due to prolonged submersion in a marsh showed severe rhabdomyolysis. Conservative fluid therapy effectively treated his acute kidney injury, highlighting its potential even in elderly patients.
Area of Science:
- Emergency Medicine
- Nephrology
- Toxicology
Background:
- Crush syndrome can result from prolonged immobility and tissue damage.
- Elderly patients may have reduced physiological reserves, increasing risks associated with crush syndrome.
- Rhabdomyolysis, characterized by muscle breakdown, is a common complication of crush injuries.
Observation:
- A 90-year-old male was rescued after 18 hours in a marsh, presenting with abrasions and significantly elevated serum creatine phosphokinase (CPK) levels.
- CPK levels rose dramatically, indicating severe muscle damage.
- The patient developed oliguria and acute kidney injury (AKI) with elevated creatinine.
Findings:
- Despite the severity of rhabdomyolysis and AKI in a very elderly patient, conservative fluid therapy led to renal function recovery.
- Hemodialysis was considered but ultimately not required.
- This case demonstrates a favorable outcome with non-invasive management.
Implications:
- Conservative fluid therapy can be an effective and accessible treatment for crush syndrome-induced AKI, even in nonagenarians.
- This approach may obviate the need for more invasive treatments like hemodialysis in select cases.
- Further research into optimal fluid management strategies for elderly patients with crush syndrome is warranted.