The mechanism is believed to be the release into the bloodstream of muscle breakdown products—notably myoglobin, potassium and phosphorus—that are the products of rhabdomyolysis (the breakdown of skeletal muscle damaged by ischemic conditions). The specific action on the kidneys is not understood completely, but may be due partly to nephrotoxic metabolites of myoglobin. The most devastating systemic effects can occur when the crushing pressure is suddenly released, without proper preparation of the patient, causing reperfusion syndrome. In addition to tissue directly suffering the crush mechanism, tissue is then subjected to sudden reoxygenation in the limbs and extremities. Without proper preparation, the patient, with pain control, may be cheerful before recovery, but die shortly thereafter. This sudden failure is called the "smiling death".These systemic effects are caused by a traumatic rhabdomyolysis. As muscle cells die, they absorb sodium, water and calcium; the rhabdomyolysis releases potassium, myoglobin, phosphate, thromboplastin, creatine and creatine kinase.Crush syndrome can directly come from compartment syndrome, if the injury is left untreated. Symptoms include the 5 Ps: pain, pallor, paresthesias (pins and needles), paralysis, and pulselessness. Treatment
There is no distinct treatment option that can undo the effects and damage from rhabdomyolysis because it is a necrosis. However, the rate of the pathology that can lead to more complications can be decreased by acting early and consistently. Overall treatment depends on preventing kidney failure (renal failure) which is done by rehydrating the patient. It also depends on making urine have a more basic pH (alkalinization of urine).
The term leukemoid reaction describes an increased
white blood cell count (> 50,000 cells/μL), which is a physiological response to stress or infection (as opposed to a primary blood malignancy, such as leukemia). It often describes the presence of immature cells such as myeloblasts or red blood cells with nuclei in the peripheral blood. It may be lymphoid or myeloid. Causes
As noted above, a leukemoid reaction is typically a response to an underlying medical issue. Causes of leukemoid reactions include:
Severe hemorrhage (retroperitoneal hemorrhage)
Drugs
Use of sulfa drugs
Use of dapsone
Use of glucocorticoids
Use of G-CSF or related growth factors
All-trans retinoic acid (ATRA)
Ethylene glycol intoxication
Infections
Clostridium difficile
Tuberculosis
Pertussis
Infectious mononucleosis (lymphocyte predominant)
Visceral larva migrans (eosinophil predominant)
Asplenia
Diabetic ketoacidosis
Organ necrosis
Hepatic necrosis
Ischemic colitis
As a feature of trisomy 21 in infancy (incidence of ~10%)
As a paraneoplastic phenomenon (rare)

Diagnosis
Conventionally, a leukocytosis exceeding 50,000 WBC/mm3 with a significant increase in early neutrophil precursors is referred to as a leukemoid reaction. The peripheral blood smear may show myelocytes, metamyelocytes, promyelocytes, and rarely myeloblasts; however, there is a mixture of early mature neutrophil precursors, in contrast to the immature forms typically seen in acute leukemia. Serum leukocyte alkaline phosphatase is normal or elevated in leukemoid reaction, but is depressed in chronic myelogenous leukemia. The bone marrow in a leukemoid reaction, if examined, may be hypercellular but is otherwise typically unremarkable.Leukemoid reactions are generally benign and are not dangerous in and of themselves, although they are often a response to a significant disease state (see Causes above).