Adult Respiratory Distress Syndrome Associated with Crush Syndrome

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Dear Sir, Crush syndrome with muscle trauma or compression is a well-known cause of acute renal failure (ARF).Except for ARF.other organ failure is an uncommon complication if other sequelae, such as sepsis and multiple organ failure (MOF).can be prevented.We herein report a case of ARF with adult respi ratory distress syndrome (ARDS) associated with crush syndrome.A 33-year-old female without any medi cal history was referred from another hospi tal because of anuria for 24 h.Three days previously, she had slipped and fallen on the pavement and had been accidentally trapped for l h and 45 min under an open door of the car in which she had been about to ride.Physical examination at the time of admis sion to our hospital disclosed a conscious woman; temperature 37.4°C, heart rate 94 beats/min, and blood pressure 116/ 70 mm Hg.There were signs o f extensive compression with abrasions on the trunk and limbs.A chest X-ray revealed a fracture of the right 9th rib and the left 6th rib but no damage to the bilateral lungs.Abdominal computed tomography scan showed no ab normality of the abdominal organs but indi cated edema of the iliopsoas muscle.Labora tory studies showed: hemoglobin 7.5 g/dl.hematocrit 21.7%.white cell count 25.500/ pi, platelets 20.1 x 10J/pl.blood urea nitro gen 81 mg/dl.serum creatinine 9.0 mg/dl.Na 138 mEq/I.K 5.0 niEq/1.bicarbonate 18.0mEq/l, creatine phosphokinasc (CPK) 39,000 I U/l.myoglobin 22,000 ng/1, aspar tate aminotransferase 1.689 IU/1.alanine aminotransferase 298 IU/1.lactate dehydro genase 4.010 IU/1.

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