Pattern of Electrolyte Imbalance in Hospitalized DiabeticPatients 22% were on oral anti-diabetic agents and 6% were on medical nutrition therapy. Among the co-morbidities, hypertention was the most prevalent (61%), followed by ischaemic heart disease (24%), chronic kidney disease (21%), dyslipidaemia (8%) and fatty liver (4%). Diabetic peripheral neuropathy was present in 41% cases, nephropathy in 13% cases and retinopathy in 12% cases. Over all 78% (100 patients had electrolyte imbalance out of 128 patients) of patients had some sort of electrolyte imbalance, irrespective of cause of admission. Hyponatraemia was the most common electrolyte imbalance in this study (80%), followed by hypomagnaesemia (38%), hypokalaemia (36%) and hyperkalaemia (14%). In 11% cases there were hyponatraemia, hypokalaemia and hypomagnaesemia. Regarding the precipitating factors, vomiting was most common (51%). In 28% cases electrolyte imbalance was precipitated by various drugs. Diarrhea and renal failure were responsible in a minority of cases. In 4% cases no cause could be identified. No death occurred.Conclusion: From this cross-sectional study it can be concluded that, electrolyte imbalance is common in hospitalized diabetic patients. Serum electrolytes should be checked routinely in hospitalized diabetic patients irrespective of their purpose of admission.
Melioidosis is an emerging infectious disease in many countries including Bangladesh. Genitourinary infection due to Burkholderia pseudomallei is a well-recognized manifestation although less commonly reported in Asia than Australia. Here, we report case history of a 38-year-old Bangladeshi farmer, diagnosed with IgA nephropathy and on oral prednisolone, who presented with features of urinary tract infection. Diagnostic workup confirmed genitourinary infection due to B. pseudomallei and diabetes mellitus. He was treated with ceftazidime followed by the combination of co-trimoxazole and doxycycline. After two-year follow-up, he was free of symptoms with no recurrence of melioidosis. In the context of growing evidence of melioidosis endemicity in Bangladesh, physicians should be aware and include melioidosis as differential in appropriate clinical scenario. Melioidosis may cause urinary tract infections and should be suspected in high-risk groups like farmers and in the presence of risk factors such as diabetes mellitus and other immunosuppressive conditions.
Escherichia coli and Klebsiella pneumoniae are responsible for UTI in 80-90% cases [2][3][4] . Extended-spectrum beta-lactamase (ESBL) producing E. coli and K. pneumoniae are increasingly being isolated in cultures from urine samples in Bangladesh 5-8 . Advanced age, diabetes mellitus (DM), use of urinary catheters, previous hospital admission and antibiotic intake are reported as risk factors for ESBL positivity 9,10 . Data regarding ESBL positive organisms are limited in our country. This study was designed to describe the frequency of ESBL positive E. coli and K. pneumoniae causing UTI, their associated risk factors and antibiotic sensitivity pattern in a tertiary care setting of Bangladesh. Methods :This prospective cross-sectional study was done in the Department of Nephrology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh from January 2014 to March 2014. Adult patients who got admitted with a clinical diagnosis of UTI were initially enrolled for the study. Those with a growth of micro-organism from their urine samples were then selected for the study and finally one hundred consecutive culture positive UTI cases due to E. coli or K. pneumoniae infection, irrespective of their ESBL positivity were purposively included in this study. Original
Abstract:Toxin is a common cause of community acquired acute kidney injury (AKI) which includes environmental toxins like plant toxins as well as various drugs and chemicals which are usually ingested for medicinal as well as recreational purposes.Averrhoa carambola (Star fruit/ Kamranga) and Avorrhoa bilimbi are two such commonly used traditional remedies. They belong to family Oxalidaecae and contain high-levels of oxalic acid. AKI may occur after consuming concentrated juice due to deposition of oxalate crystals in the renal tubules.Here we present two patients who developed AKI after ingestion of freshly made juice from A. bilimbi and star fruit. Both patients were diabetic and the juice was ingested on empty stomach with the belief of improving glycemic status. Initial presentation was GI upset in both scenarios. Patient with A. bilimbi toxicity had diabetic nephropathy and required hemodialysis. Renal biopsy revealed deposition of polarizable oxalate crystals in the patient who consumed A. bilimbi and acute tubular necrosis in the patient with star fruit toxicity. All cases regained normal renal function within three months.We also present a patient who ingested raw fish gallbladder as a remedy for asthma. The patient presented with AKI within five days of ingestion and required hemodialysis. His highest serum creatinine was 10.4mg/dl and fell to 1.7 mg/dl after four weeks. Cyprinol and related compounds in fish gallbladder are thought to be the cause of acute tubular necrosis in such cases.The fourth patient developed AKI with rhabdomyolysis after consuming a locally made energy drink. He also required dialysis and serum creatinine gradually improved from 7.2mg/dl to 1.4mg/dl at discharge. The possibility of toxicity of caffeine, adulteration with other chemicals or ascorbic acid toxicity causing oxalate nephropathy could not be excluded.All four patients developed AKI caused after ingesting easily available products and are presented here for public awareness. We believe proper knowledge and education can reduce toxin induced AKI in our society.
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