In crush syndrome management, which solution is commonly used to help prevent renal injury during treatment?

• A. Dextrose
• B. Bicarbonate
• C. Normal saline
• D. Potassium chloride

Answer: (B)

Alkalinizing the urine with bicarbonate helps prevent kidney injury in crush syndrome. When muscle tissue is damaged, myoglobin is released and filtered by the kidneys. In acidic urine, myoglobin tends to precipitate and form casts that block tubules and generate toxic injury. Infusing sodium bicarbonate raises urine pH, making myoglobin more soluble and reducing cast formation, while also promoting diuresis to wash the kidneys. This is usually done alongside large-volume isotonic saline to maintain hydration and urine output. Other options don’t provide this protective alkalinizing effect and Potassium chloride would worsen potassium load.