ABSTRACT
Objectives:Renal impairment in Patients with chronic liver disease is a common phenomenon and is a functional impairment. It seems difficult for the assessment of renal function abnormalities by normal parameters. We aimed to determine the usefulness of creatinine clearance by timed urine collection and Cockcroft Gault formula and Serum creatinine as parameters in assessing renal function in this cohort of patients and also to find if etiology of chronic liver disease has a bearing on renal dysfunction. Material and methods:Renal parameters of 200 patients with chronic liver disease were studied to assess the reliability of the each parameter. Results: In the present study, Only 22% of alcoholics have clearance more than 60ml/min. 58% patients were found to have creatinine clearance more than 60ml/min by Cockcroft Gault formula while only 36% Patients have that by timed urine collection where the difference was found to be statistically significant (Pvalue<0.01). Cockcroft Gault formula overestimates probably due to disparity in weight due to fluid retention. Conclusion:ThemostreliableParameterin our clinicalsetup isCreatinine clearance by timed urine collection.Presence ofAscites,lowserumalbumin levels andAlcoholic etiologyhadmorepredispositiontorenalimpairment,however, a largerstudywithmorenumber ofpatients canthrowmore ligh
ABSTRACT
Malaria is re-emerging as the major infectious killer and it is the top priority tropical disease of the World Health Organization. Indian sub-continent harbours a global threat in the form of epicenter of multidrug resistant plasmodium falciparum. High prevalence of Complicated Falciparum Malaria in Costal Andhra Pradesh requiring ICU admission with high morbidity and mortality prompted this study. 60 cases of falciparum malaria in 3 sub groups, i.e, uncomplicated falciparum, severe falciparum with ARF, severe falciparum without ARF are taken. In Group-II, i.e, severe falciparum with ARF pts., mean serum potassium is 5.06 -hyperkalemia, mean PaO2 and PaCO2 are 80.33 and 32.75 respectively and mean bicarbonate value is 19.83, mean PH is 7.10, which reflects underlying metabolic acidosis and compensatory respiratory alkalosis, also mortality is 6 in Group-II out of total 9 deaths. Hence electrolytes and acid-base disturbance, especially hyperkalemia and acidosis are important cause of mortality in severe falciparum malaria. In acute renal failure setting, which is associated with both hyperkalemia and acidosis, prognosis is worsened. “Humanity has but three great enemies : fever, famine and war; of these by far the greatest, by far the most terrible, is fever(William Osler).