18100006004 THESIS

TITLE:

ACID BASE CHANGES IN ACUTE DIARRHEAL DISEASES IN A RURAL TERTIARY CARE HOSPITAL


INTRODUCTION:

Acid-base disorders are a group of conditions characterized by changes

in the concentration of hydrogen ions (H+) or bicarbonate (HCO3-), which lead to

changes in the arterial blood pH. Disorders of acid-base homeostasis complicate

a variety of disease conditions and contribute to morbidity and mortality. If not

promptly recognized, these disorders interrupt normal functioning of various

organ systems and ultimately prove fatal.


The clinical settings in which such acid-base disorders occur are

numerous, an attempt to list out all the causes of acid-base disturbances will be

exhaustive and unwarranted. Nevertheless, to make some simplification, it can

be said, diseases of the lungs and kidneys (the two important organs involved in

acid-base homeostasis), contribute to an important proportion of such acid base

disturbances.


Acute Diarrheal Disease is yet another cause of acid-base and electrolyte

disturbance and the present study aims to explore the various changes that take

place in the acid base status of patients who suffer an acute diarrheal disease.

Diarrhea can cause a variety of fluid volume, acid-base, and electrolyte

abnormalities and causes alterations in serum chemistries.


The study tries to validate a prognostic role for those acid-base changes

in acute diarrheal disease and calls for an early recognition and correction of

acid-base changes.


AIM:

To Study Acid base changes in patients with acute diarrhea.


OBJECTIVES:

1. To Determine the acid-base disturbances (ABG, ANION GAP) resulting

from acute diarrheal disease.

2. To study the changes in acid-base status in patients with acute renal failure

due to acute diarrheal disease.

3. To find out severe metabolic acidosis (pH < 7.2 or pH=7.2) in acute

diarrheal disease.

4. To study the outcome of patients in relation to severity of metabolic

acidosis.


MATERIALS AND METHODS

Study Design

This study is a prospective study

Study Setting

All patients with acute diarrhea admitted in Department of General Medicine, Kamineni

Institute of Medical Sciences, Narketpally, Nalgonda (Dist),Telangana .

Study Period

This study was conducted between October 2018 to September 2020.


Inclusion Criteria

Patients More than 12 years of age, who presented with acute diarrheal were

included.

Both sexes are included in the study.


Exclusion Criteria

Since this study aims at identifying the acid-base changes occurring as

a result of acute diarrhea, the following patients were excluded.

1) Patients who had coexisting diseases like chronic obstructive pulmonary

disease(COPD),

Patients with Diabetes Mellitus (who might have Type IV RTA –

hyporeninemic hypoaldosteronism), Hepatic disease and chronic kidney

diseases are excluded, because these Diseases might themselves

produce Changes in ABG.

2) Patients who are taking drugs that are likely to produce Acid-Base

disturbances are also excluded.

Ex. Metformin (for PCOD)

Cholestyramine

Calcium or Magnesium chloride

Acetazolamide

3) Drugs causing RTA (Renal Tubular Acidosis)

Ex. Cotrimoxazole

Spironolactone

Triamterene


STUDY POPULATION

The study included 72 patients, 40 males and 32 females. The youngest

patient in the study was 13 years of age and the oldest patient was 85 years of

age. All satisfied the inclusion and exclusion criteria.


STUDY PROTOCOL AND LABORATORY INVESTIGATIONS

In all patients preliminary history regarding duration of Loose Stools,

presence of vomiting and Reduced Urine output was recorded.

Clinical examination was done to identify the degree of dehydration,

acidotic breathing if any, vital signs and other systems examination to rule out

any preexisting diseases that might confound the acid-base picture.

In all patients routine urinalysis for albumin, sugar deposits were done.

Also urine was examined for acetone, since patients with diarrhea might starve

leading to starvation keto acidosis.

In all patients hemogram was routinely done. It is mandatory to know the

hemoglobin level for determining oxygen content of blood in ABG analysis.

If any of the patients were found to have renal failure (defined as serum

creatinine > 2mg %), subsequent serial measurements were made as

appropriate and after treatment.


Treatment Protocol Followed

All patients were treated for rehydration with oral fluids, ORS and with IV

Fluids (2:1 saline, lactate cycle) as required. (34)

If any patient was found to have severe acidosis (PH< 7.2) bicarbonate

was administered intravenously. About 50-75ml. of 7.5% sodium bicarbonate

was slowly infused intravenously over a period of one hour.

If the patient presented with raised renal parameters fluid challenge with

1.0 to 1.5 liters of IVF was given. If the patient shows any improvement in urine

output and clinical Signs and Symptoms, rehydration therapy was continued. If

the patient had persistent oliguria despite rehydration and other uremic

manifestations mandating dialysis, peritoneal or haemodialysis was undertaken.

Regular monitoring of renal functions was also done. Antibiotics were given as

appropriate. Patients were discharged once diarrhea stopped and renal

functions returned to normal if they initially had renal failure.


MASTER CHART:

https://docs.google.com/spreadsheets/d/15a_FiG_kvhkflxFPvEZ-wm81TVEkSCWH/edit?usp=drivesdk&ouid=108872713690900170464&rtpof=true&sd=true


LINK TO COMPLETE THESIS WITH MASTER CHART:

https://drive.google.com/file/d/1sgI_2Yjz_yW-g_fcZmGPUlyrXP9ZXZVy/view?usp=drivesdk

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