Crush syndrome

What is it?

Crush syndrome is a condition caused when an excessive force is applied to a group of muscles for a long time. If the injury damages, which damages the muscles very severely, a toxic protein called myoglobin and others like potassium and phosphorus are released in large quantities in the body. The toxins are released from the muscles in the area where the load is the maximum. These toxins enter the blood stream and reach the heart. In most cases, this degeneration of muscle starts about 20 minutes after the muscle has been crushed. These toxins may result in life threatening complications like acute kidney failure, heart attack and blockage of blood vessels. Kidney failure is caused due to blockage of the tubules that filter the waste. These toxins block the tubules destroying the kidney cells. This can result in kidney failure requiring dialysis.

What are the causes?

Apart from being caused by injury to the muscle, crush syndrome may have other causes:Hereditary causes – there may be inherent defects in the body's carbohydrate digesting mechanism. It may be caused due to excessive exertion or heat stroke.Alcoholism induced coma or seizures. Some drugs and toxins may also cause this syndrome. These include some cholesterol lowering drugs like clofibrate and gemfibrozil.

What are the symptoms?

The syndrome is generally marked by very specific symptoms that can be easily detected by the doctor. Some of them are: Decreased blood supply to the brain due to shock (hypovolaemic shock) resulting in altered consciousness or even coma. Muscular weakness due to increased potassium in the blood Pale, cold and clammy skin Weak and rapid pulse Absence of pain in the affected region Decreased urine output.

How is the diagnosis made?

The condition is diagnosed by conducting certain tests like urine myoglobin, serum CPK and a host of chemical test including serum creatinine, BUN and a total bilirubin count.

What is the treatment?

The simplest form of treatment is to make the patient consume a lot of water and other liquids. This helps to dilute the acid concentration of the blood and also helps the kidneys to excrete myoglobin better. This ensures adequate availability of fluids and oxygen to all the tissues.Before medical aid arrives, some first aid may be provided to the victim. This includes pulling away excessive load from the victim's head, chest and abdomen. The patient should be constantly reassured till medical help is available and should be treated for any other minor injuries. However, treatment measure is primarily surgical in case the limb is crushed very badly and has lost the ability to function.Fluids may need to be given into the vein. The crushed tissues need to be removed urgently by an operation. If there is kidney failure, the patient may need dialysis.

DoctorNDTV Team