OBSERVATIONAL STUDY OF ACUTE DIARRHEAL DISEASES IN RELATION TO ACID BASE CHANGES AND ACUTE KIDNEY INJURY

Dr Bh.V.K. Praveen varma; Dr K L Behera; Dr Siva Krishna Sirasapalli; Dr S. C. Mahapatra; Dr Vineesha Kamini

Volume : VIII, Issue : II, February - 2018

OBSERVATIONAL STUDY OF ACUTE DIARRHEAL DISEASES IN RELATION TO ACID BASE CHANGES AND ACUTE KIDNEY INJURY

Dr Bh. V. K. Praveen Varma, Dr K L Behera, Dr Siva Krishna Sirasapalli, Dr S. C. Mahapatra, Dr Vineesha Kamini

Abstract :

BACKGROUND

Disorders of acid–base homeostasis complicate a variety of disease conditions and contribute to morbidity and mortality. These disorders disrupt normal functioning of various organ systems and ultimately prove fatal. 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.

MATERIALS AND METHODS

In all patients, history regarding duration of diarrhea, presence of vomiting and oliguria was recorded. Clinical examination was focused on identifying the degree of dehydration, acidotic eathing, vital signs and systemic examination to rule out coexisting diseases that might confound the acid–base picture. In all patients, routine urinalysis for albumin, sugar, acetone and deposits was done. In all patients, hemoglobin estimation was routinely done. If any patient was found to have renal failure (defined as serum creatinine)>2 mg%) serial measurements were made as appropriate and after treatment.

RESULTS

28 out of 104 patients with acute diarrhea had ARF. All 28 patients had increased anion gap metabolic acidosis. 14 out of 104 patients with acute diarrhea had severe metabolic acidosis (pH <7.2). Out of these 14 patients, 10 had renal failure and 4 patients had normal renal parameters.

CONCLUSION

The most common acid–base disturbance observed in patients with acute diarrheal disease is normal anion gap metabolic acidosis. A normal ABG must be interpreted in the clinical context because mixed acid–base disorders may produce normal values in ABG analysis. The acid–base abnormality observed in post diarrheal ARF is increased anion gap metabolic acidosis. Metabolic acidosis is a prognostic factor and early recognition and prompt correction of metabolic acidosis improves the outcome in acute diarrheal disease and post diarrheal ARF.