‘’TO EVALUATE ACID-BASE DISTURBANCES IN ACUTE DIARRHEAL ILLNESS’

Main Article Content

Dr. Divya
Dr. Sanjay Dhawale
Dr. Ragini Tarole
Dr. Seema

Keywords

.

Abstract

Introduction- Diarrhea can cause a variety of fluid volume, acid-base and electrolyte abnormality which can cause disruption of various organs functioning and also complicate the disease itself to contribute it to morbidity and mortality.


Maintenance of Acid- base balance requires the cooperation of three major organs: liver, kidneys and lungs. So, it can be said that the disease of these organs can contribute to an important proportion of acid- base disturbances.


Aims and objectives- Main aim of study is ‘’To evaluate acid-base disturbances in acute diarrheal illness’’.


An observational study was conducted on 96 patients admitted in general ward at Department of Medicine, G.R. Medical College and JAH Group of hospitals, Gwalior. These patients were assessed at the time of admission by a detailed history taking and duration of illness also giving due importance to comorbidities like diabetes, chronic renal disease, COPD, any drug history, etc. A thorough clinical examination was done for patients which included general examination, vitals, and other systemic examinations.


Results- Among the studied 96 patients, maximum cases belong to the two age groups 20-29 years and 40-49 years with mean age 40.08. Out of studied 96 patients, 50 were males and 46 were females. Among diarrheal illness patients, 88 were having duration of illness <7 days and 8 patients were having duration ≥ 7days. Out of 96 patients, 56.3% of study participants were severely dehydrated, 28.1% were moderately dehydrated and only 15.6% were mildly dehydrated. Among diarrheal illness patients, it was observed that Sinus tachycardia, sinus tachycardia with U wave and with flat T wave was found statistically associated. Majority of ECG changes were found in severely dehydrated patients. Out of 96 patients, it was found that 31.3% participants were having metabolic acidosis and only 6.3% were having high anion gap in ABG analysis.


Conclusion- The most common acid-base abnormality apart from normal ABG study, observed in patients with acute diarrheal disease is NORMAL ANION GAP METABOLIC ACIDOSIS. Increased anion gap metabolic acidosis is the acid-base abnormality observed in post diarrheal ARF. In acute diarrheal illness and post diarrheal acute renal failure, metabolic acidosis is a prognostic factor and its outcome can be improved                      with early recognition and correction.

Abstract 82 | pdf Downloads 33

References

1. Acute Diarrheal Disease, Epidemiology of Communicable Diseases – 25th edition, ``PARKS TEXT BOOK OF PREVENTIVE AND SOCIAL MEDICINE``.
2. Diarrhea – B.S. Ramakrishna, Gastroenterology, 12th Eiditon, ``API TEXT BOOK OF MEDICINE``.
3. Hydrogen Ion Concentration ``INTERPRETATION OF BLOOD GASES`` ``ROBERT L.WILKINS, 7th Edition, Clinical Assessment in Respiratory Care`` by Wilkins, Krider and Sheldon.
4. Introduction to Acid Base Physiology – 7. ``Understanding Acid Base Balance`` by Benjamin Abelow M.D.,
5. Transport of oxygen and Carbondioxide in Blood and Body Fluids– 40. `TEXT BOOK OF MEDICAL PHYSIOLOGY`` - 14th Edition, Guyton and Hall.
6. ``Understanding Acid Base Balance`` by Benjamin Abelow M.D., .Acidosis and Alkalosis–42,Thomas B. Dubose JR. ``HARRISONS PRINCIPLES OF INTERNAL MEDICINE`` Volume 1, 20th Edition.
7. Buffering of Hydrogen Ions in Body Fluids, Regulation of Acid Base Balance – 30, `TEXT BOOK OF MEDICAL PHYSIOLOGY``- 14th Edition, Guyton and Hall.
8. Role of the Kindeys in Acid Base Balance, Urinary Stones, Nephrocalcinosis and Renal Tubular Acidosis – 20.13 Robert J. Unwin William G. Robertson. ``OXFORD TEXT BOOK OF MEDICINE`` 5th Edition.
9. Acute Renal Failure due to Acute Diarrheal Diseases –S. Shivakumar, M.A. Muthusethupathi, JAPI Vol.38. Feb-1990.
10. Gastrointestinal causes of Metabolic Acidosis, Chapter 16,``UNDERSTANDING ACID BASE BALANCE`` by Benjamin Abelow M.D.,
11. Clinical Acid-Base Disorders – 2.6. by Biff. F.Palaer, Robert G. Narins and Jerry Yee in ``OXFORD TEXT BOOK OF CLINICAL NEPHROLOGY`` 5th Edition, Volume-1.
12. Metabolic causes of Metabolic Acidosis by Benjamin Abelow in`` UNDERSTANDING ACID BASE BALANCE`` by Benjamin Abelow.
13. Metabolism of Ketone Bodies, in Chapter – 13, Lipids – Part II, ``TEXT BOOK OF BIOCHEMISTRY`` Vasudevan, 10th Edition.
14. Clinical Acid-base Disorders – 2.6. by Biff. F.Palaer, Robert G. Narins and Jerry Yee in ``OXFORD TEXT BOOK OF CLINICAL NEPHROLOGY`` 5th Edition, Volume-1.
15. Disorders of Hydrogen Ion Homeostasis – In ``CLINICAL CHEMISTRY``- 5th Edition by William J. Marshall and Stephen K. Bengert.
16. Interpretation of Arterial Blood Gases, Chapter 6, by Robert L. Wilkins in ``CLINICAL ASSESSMENT IN RESPIRATORY CARE`` 4th Edition, Wilkins, Krider and Sheldon.
17. Acid-Base Disturbances in ``THE WASHINGTON MANUAL OF MEDICAL THERAPEUTICS`` 36th Edition.
18. Limitations of Compensation for Acid Base Disorders in Interpretation of Arterial Blood Gases, Chapter 6, by Robert L.WILKINS,8th Edition, ``CLINICAL ASSESSMENT IN RESPIRATIORY CARE`` by Wilkins, Krider and Sheldon.
19. ``Anion Gap`` in Acidosis and Akalosis by Thomas D. Dubose, JR. in 20th Edition HARRISON‘S PRINCIPLES OF INTERNAL MEDICINE Volume 1, 20th Edition.
20. . Metabolic Acidosis in Acid-base disturbances in ``THE WASHINGTON MANUAL OF MEDICAL THERAPEUTICS`` 31st Edition.
21. Treatment of Metabolic Acidosis. Thomas D. Dubose, JR. in 19th Edition, HARRISON‘S PRINCIPLES OF INTERNAL MEDICINE Volume 1, 19th Edition.
22. Base Excess and Base Defecit, ``CLINICAL ASSESSMENT IN RESPIRATORY CARE`` 4th Edition, Wilkins, Krider and Sheldon.
23. Arterial Blood Sampling ``CLINICAL ASSESSMENT IN RESPIRATORY CARE`` 4th Edition, Wilkins, Krider and Sheldon.
24. Acute Renal Failure due to Acute Diarrheal Diseases –S. Shivakumar, M.A. Muthusethupathi, JAPI Vol.38. Feb-1990.
25. Metabolic Acidosis in Renal Failure, Acidosis and Akalosis by Thomas D. Dubose, JR. in 20th Edition HARRISON‘S PRINCIPLES OF INTERNAL MEDICINE Volume 1, 20th Edition.
26. ``ACID BASE CHEMISTRY AND BUFFERING`` by Madias NE.
27. Halpern ML. ``BIOCHEMISTRY AND PHYSIOLOGY OF AMMONIUM EXCRETION``. Chapter 76 in ``THE KIDNEY`` by knepper MA.
28. Winter SD. The fall of serum anion gap. Arch. Internal Medicine 1990; 150:311-313.
29. ``Mixed-Acid Base Disorders, Clinical Examples`` Harrington JT. Allen S. J., Okoko B., Martinez E., Gregorio G., Dans L. F. Probiotics for Treating Infectious Diarrhea. Cochrane Database Systematic Reviews. 2004;(2):CD003048. [PubMed]
30. Peter G., Myers M. G. the National Vaccine Advisory Committee, and the National Vaccine Program Office. . Intussusception, Rotavirus, and Oral Vaccines: Summary of a Workshop. Pediatrics. 2002;110:e67. [PubMed]
31. Ronsmans C., Bennish M. L., Wierzba T. Diagnosis and Management of Dysentery by Community Health Workers. Lancet. 1988;8610:552–55. [PubMed]
32. Ruxin J. N. Magic Bullet: The History of Oral Rehydration Therapy. Medical History. 1994;38:363–97. [PMC free article] [PubMed]
33. Ryan E. T., Calderwood S. B. Cholera Vaccines. Clinical Infectious Diseases. 2000;31:561–65. [PubMed]
34. Salam M. A. Antimicrobial Therapy for Shigellosis: Issues on Antimicrobial Resistance. Japanese Journal of Medical Science and Biology. 1998;51(Suppl.):S43–62. [PubMed]
35. Santos ., Victora C. G., Martines J., Goncalves H., Gigante D. P., Valle N. J., Pelto G. Nutrition Counseling Increases Weight Gain among Brazilian Children. Journal of Nutrition. 2001;131:2866–73. [PubMed]
36. Snyder J. D., Merson M. H. The Magnitude of the Global Problem of Acute Diarrhoeal Disease: A Review of Active Surveillance Data. Bulletin of the World Health Organization. 1982;60:604–13. [PMC free article] [PubMed]
37. Tucker A. W., Haddix A. C., Bresee J. S., Holman R. C., Parashar U. D., Glass R. I. Cost-Effectiveness Analysis of a Rotavirus Immunization Program for the United States. Journal of the American Medical Association. 1998;279:1371–76. [PubMed]
38. Victora C. G., Bryce J., Fontaine O., Monasch R. Reducing Deaths from Diarrhoea through Oral Rehydration Therapy. Bulletin of the World Health Organization. 2000;78:1246–55. [PMC free article] [PubMed]
39. WHO (World Health Organization). 1997. Health and Environment in Sustainable Development Five Years after the Health Summit. WHO/EHG/97.8. Geneva: WHO.