JUST one tablet of paracetamol (acetaminophen) could help save earthquake survivors who otherwise risk dying from kidney failure after rescue. Experiments in rats have shown that the drug prevents “crush syndrome”, or , in which muscle debris from crushed limbs floods the kidneys soon after the limb is freed from rubble, causing them to fail.
“When you release the pressure on muscle through rescue, debris goes to the kidney. It’s like a chain reaction, and acetaminophen blocks it,” says of Vanderbilt University in Nashville, Tennessee, and head of the research team.
The destruction of muscle through crushing leads to the release of myoglobin, a protein vital for delivering oxygen to muscle and other tissue. When the myoglobin reaches the kidneys it clogs the tubules and produces harmful chemical agents called free radicals.
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These free radicals destroy fatty membranes in the kidney, which die and turn black. They also trigger constriction of blood vessels, cutting off blood flow to the kidney and halting filtration of blood, rapidly leading to death through kidney failure. The condition became known as the “smiling death” in China after apparently uninjured victims died.
After inducing crush syndrome in rats via muscular injections of sugar, Boutaud and colleagues demonstrated that the human-equivalent dose of acetaminophen successfully blocked both of these processes, whether given before or shortly after the injury (Proceedings of the National Academy of Sciences, ).
Although the finding has come too late to save lives following the quake in Haiti, Boutaud is hopeful that the treatment can be validated in humans before, or even during, the next big quake. “We don’t know yet whether it would work, or how soon we’d need to give it to prevent kidney damage,” he says, “but we must try because it could save thousands of lives.”
“We don’t know whether it would work, but we must try because it could save thousands of lives”
Martin de Smet of will refer Boutaud’s results to the , which has developed validated protocols for treating crush-syndrome victims, involving the rapid infusion of saline fluids. The drug might be testable as a supportive treatment, he says.
