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Rhabdomyolysis may be caused by sustained, continuous pressure to skeletal muscle. The syndrome is characterized by hypovolemia, hyperkalemia and release of excessive amounts of myoglobin to the circulation. If untreated, the syndrome becomes complicated by potentially fatal acute renal failure. Two case reports are presented which illustrate the importance of early and aggressive fluid substitution where forced alkaline diuresis seemed to prevent life threatening renal complications.

Rhabdomylosis following crush injuries represents an occupational hazard in the off-shore fisheries. In northern countries this can be complicated by hypothermia and a long transport time to the nearest hospital. If treatment is delayed, what is initially a local limb injury can result in a potentially life threatening acute renal failure as a result of the nephrotoxic effects of the various intracellular muscle components released into the circulation. Therefore early and aggressive fluid treatment in the field, and during the transport of crush injury victims is very important. Forced alkaline diuresis is the main prophylaxis against hyperkalemia and acute myoglobinuric renal failure. A case history which demonstrates some of the aspects and challenges in the treatment of crush injuries is presented.