A pilot study on electrolyte and water losses in patients AIDS-related persistent diarrhoea amd mulnutrition at University Teaching Hospital, Lusaka.
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Date
2012-06-15
Authors
Kaile, Trevor
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Abstract
Chronic diarrhea results in salt and water loss resulting in blood volume depletion which may lead to hypovolaemia, postural hypotension and deterioration in quality of life. These may be compounded by metabolic derangements and malnutrition so that these patients suffer from a persistent diarrhea-malnutrition syndrome.
We carried out a pilot study at the University Teaching hospital, Lusaka, in order to analyze the severity of metabolic deficits in relation to salt and water losses in AIDS related persistent diarrhoea. 12 patients completed a full evaluation and monitoring after 3 litres of normal saline fluid challenge daily over a 3 day period. A clinical examination was done and Karnofsky score noted on day one. In addition a spot urine sample and a blood sample were collected at 09:00 hours, before fluid challenge, for measurement of baseline values for urine sodium and for serum sodium, potassium, glucose, creatinine and aldosterone.
The urine and blood collection was repeated every day for the next three days after the 24 hour fluid challenge to monitor the subject's response. The subjects had an electrocardiogram done on day one to detect any heart abnormalities which may contraindicate participation in the study. On day four, a second and final Karnofsky score was noted to observe for any improvements in the subjects.
This pilot study was able to show that in persistent diarrhea patients have severe salt and water deficits and that the 3 litres daily fluid challenge was not enough to fully restore blood volume. It was also shown that half of the subjects had adrenal cortical failure which made homeostasis of electrolytes difficult to restore. All subjects examined were in a hypoglycaemic state but only one renal failure.
Although the subjects had evidence of Na+ and water depletion, there was no evidence of postural hypotension. Overall the study was able to show that infusion with normal saline improved the blood pressure, the quality of life and well being of the subjects over three days. However the amount of 3 litres of fluids was not adequate to restore serum electrolytes and effective plasma osmolarity.
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Keywords
AIDS-related persistent diarrhoea , AIDS-related persistent malnutrition , Electrolyte and water losses in AIDS patients