skip to main content

Crush Syndrome — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateEmergency MedicineCrush SyndromeRACP Adult Medicine

A 45-year-old man presents with crush injuries to both legs after being trapped under a collapsed structure for 8 hours. After extrication and IV fluid resuscitation, his serum potassium is 6.8 mmol/L, CK is 85,000 U/L, and creatinine is 350 µmol/L with dark urine. What is the most important fluid management strategy?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — IV normal saline at 1–1.5 L/hr targeting urine output >200–300 mL/hr

Crush syndrome with rhabdomyolysis requires aggressive IV crystalloid resuscitation (normal saline preferred – avoid Hartmann's/Ringer's as potassium-containing solutions worsen hyperkalaemia) targeting urine output >200–300 mL/hr. This prevents myoglobin-induced acute tubular necrosis. IV sodium bicarbonate may be added to alkalinise urine (target pH >6.5). ECG monitoring and treatment of hyperkalaemia are critical. Dialysis may be required for refractory hyperkalaemia or severe AKI.

Reference: eTG – 2025 – Nephrology; ANZICS – 2024 – Crush Injury Guidelines