What prophylactic medication should be given prior to release for a crush injury of the lower leg that has lasted more than 4 hours?

In the case of a crush injury, particularly one that has lasted more than 4 hours, the risk of developing serious complications such as rhabdomyolysis and hyperkalemia is significantly increased. Sodium bicarbonate is administered as a prophylactic measure because it serves multiple purposes in this context.

Firstly, sodium bicarbonate can help to alkalinize the urine, which promotes the solubility of myoglobin, a protein released from damaged muscle tissue. This is important because myoglobin can accumulate in the kidneys, potentially leading to acute kidney injury. Additionally, sodium bicarbonate can help to mitigate the effects of high potassium levels in the blood (hyperkalemia), which can occur as muscle cells break down and release potassium into the bloodstream. Elevated potassium levels can lead to serious cardiac complications.

While calcium gluconate, magnesium sulfate, and normal saline have their indications, they do not specifically target the concerns that arise from a prolonged crush injury in the same way that sodium bicarbonate does. Calcium gluconate is often used to manage hypocalcemia or hyperkalemia, but it does not address the myoglobin that can lead to kidney damage. Magnesium sulfate is primarily used for specific acute management situations like seizures in eclampsia or