Incidence of drug interactions in intensive care units in tertiary care settings: Classification, facts and measures

Drug-drug interactions [DDIs] are extremely significant concern, particularly in sensitive population including pediatric and geriatric. Propensity for the development of DDIs is high in patients admitted at intensive care units [ICU]. This study was conducted to evaluate the DDIs incidence, facts and measures in ICU. From a total of 150 cases studied for ICU patients, with the mean age of 56.37+/-12.45 years, 55.33% were male and the rest were female 44.66%. The demographic information like age, gender and main diagnosis details of study participants that were extracted from the patients' clinical record. A statistically significant association between the drug interaction and the number of drugs prescribed per prescription was observed [p <0.0001]. Concerning the onset of outcome, 52% of DDIs distinguished as delayed onset of effect [past 24 hours] and 35% were categorized as rapid onset [within 24 hours]. Despite the facts regarding patient safety and minimizing DIs error, polypharmacy is still frequent in critically ill patients admitted in ICU attributed high risk of adverse reactions due to use of multiple interventions to treat severity of disease condition. Such studies may be used to develop an effective tool for the diagnosis and management of DDIs

Acute renal failure: analysis of aetiological factors and outcome

To analyse the causes of acute renal failure [ARF] and management and outcome in these cases. All patients with ARF coming to SlUT between January 1990 and December 1998 were studied. A total of 1716 ARF cases were seen. Of these 43% had medica1, 28%surgical and 17% obstetrical causes. Haemodialysis was required in 88% of patients. Overall mortality was 18%. Causes of ARF in this part of the world is different from the western world. Preventable causes e.g. gastroenteritis, obstetrical haemorrhages, torture induced rhabdomyolysis and malaria, contribute to large percentage of the ARF population

Acute renal failure [ARF] following snake bite: a study of 35 cases

Objectives To study the prevalence, common presentation and factors causing mortality in snake bite induced ARF. Methods From January 1990 to December 1998, a total of 1716 cases of ARF were registered at SlUT [criteria of defining ARF was a rise in creatinine of> 2 mg% and normal size kidneys on ultrasound in a person without any previous systemic illness]. In 35 patients there was a history of snake bite preceeding ARF. Results of laboratory investigations and modalities of renal replacement therapy and outcome were analysed. Results Among 1716 cases of ARF, 764[43.4%] were due to medical causes, 485[28.2%] surgical, 298[17.3%] obstetrical and 169 [9.8%] due to miscellaneous and unknown causes. Thirty five patients, 22 males, 13 females, age range from 6- 65 years from the medical group, developed ARF after snake bite. The most common presentation was anuria and bleeding diathesis. Haemodialysis was started immediately after admission in 31 and peritoneal dialysis in 2 patients and two died before initiation of therapy. Twenty three [66%] patients recovered from renal failure in 2-3 weeks, 6 [17%] required long term dialysis [five of them had cortical necrosis], and 6 [17%] patients expired. Conclusion Bleeding diathesis induced by snake envenomation carries bad prognosis both in terms of mortality and morbidity with irreversible renal failure being the cause. Early initiation of dialysis therapy leads to rapid renal recovery