A 23 year old male has both legs trapped under a fallen tree. He has been trapped for 6 hours and rescuers are still trying to free him. Which electrolyte abnormality should you suspect?

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Multiple Choice

A 23 year old male has both legs trapped under a fallen tree. He has been trapped for 6 hours and rescuers are still trying to free him. Which electrolyte abnormality should you suspect?

Muscle compression from a crush injury releases potassium from damaged muscle cells into the bloodstream. When someone is trapped for several hours, rhabdomyolysis can occur, leading to a rapid rise in extracellular potassium—hyperkalemia. This is especially dangerous because elevated potassium disrupts cardiac conduction and can cause serious arrhythmias, which is why it’s the key electrolyte disturbance to anticipate in crush injuries. In this scenario, six hours under a fallen tree makes hyperkalemia the most likely abnormality. Other choices don’t fit as directly: low potassium (hypokalemia) would come from losses or shifts not specifically tied to crush damage; high sodium (hypernatremia) results from dehydration but isn’t the characteristic acute issue from crush injury; low magnesium (hypomagnesemia) can occur in various conditions but isn’t the hallmark immediate problem in crush syndrome. In the field, expect ECG changes consistent with hyperkalemia and prepare for treatment to stabilize the heart and shift potassium into cells if needed—calcium to protect the myocardium, insulin with glucose, beta-agonists, and bicarbonate, along with aggressive IV fluids to support renal clearance, while ensuring rapid transport.

Muscle compression from a crush injury releases potassium from damaged muscle cells into the bloodstream. When someone is trapped for several hours, rhabdomyolysis can occur, leading to a rapid rise in extracellular potassium—hyperkalemia. This is especially dangerous because elevated potassium disrupts cardiac conduction and can cause serious arrhythmias, which is why it’s the key electrolyte disturbance to anticipate in crush injuries.

In this scenario, six hours under a fallen tree makes hyperkalemia the most likely abnormality. Other choices don’t fit as directly: low potassium (hypokalemia) would come from losses or shifts not specifically tied to crush damage; high sodium (hypernatremia) results from dehydration but isn’t the characteristic acute issue from crush injury; low magnesium (hypomagnesemia) can occur in various conditions but isn’t the hallmark immediate problem in crush syndrome.

In the field, expect ECG changes consistent with hyperkalemia and prepare for treatment to stabilize the heart and shift potassium into cells if needed—calcium to protect the myocardium, insulin with glucose, beta-agonists, and bicarbonate, along with aggressive IV fluids to support renal clearance, while ensuring rapid transport.

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