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:
LINK TO COMPLETE THESIS WITH MASTER CHART:
https://drive.google.com/file/d/1sgI_2Yjz_yW-g_fcZmGPUlyrXP9ZXZVy/view?usp=drivesdk
Comments
Post a Comment