Emerging progressive atypical acute kidney injury in young children linked to ethylene glycol and diethylene glycol intoxication.

BACKGROUND: There had been a sudden surge of unusually severe and rapidly progressing acute kidney injury (AKI) incidence in Indonesia since August 2022 which did not correspond to the rise of COVID-19 incidence. We suspected this was related to ethylene glycol (EG) and diethylene glycol (DEG) intoxication. This study is aimed at describing the clinical and laboratory characteristics of AKI related to D(EG) intoxication in order to spread awareness of the possibility of intoxication in cases of rapidly progressing AKI with unknown etiology. METHODS: We conducted a cross-sectional study by collecting secondary data from the pediatric AKI registry at a national referral hospital in Jakarta, Indonesia. Data on children admitted from January to November 2022 with diagnosis of stage 3 AKI based on KDIGO criteria were included. Data regarding demographics, symptoms prior to anuria, laboratory results, infection panel including COVID-19 status, treatment administered, and mortality were analyzed. RESULTS: Sixteen patients tested positive for EG and DEG, all with history of consuming syrup-based medications. High anion gap metabolic acidosis was observed in majority of patients with mean pH 7.33 ± 0.07 and mean anion gap 15.6 ± 7.8 mEq/L. No patient had high osmolal gap (mean osmolal gap 3.46 ± 4.68). One deceased patient, who had kidney biopsy performed, showed severe damage and calcium oxalate crystals in the kidney tissue. Mortality was recorded in six patients (37.5%). CONCLUSION: Careful history taking of patient's clinical course, including consumption of syrup-based medications and laboratory findings, might aid clinicians to establish a working diagnosis of D(EG) intoxication without needing to wait for blood toxicology test. Early diagnosis and therapy are crucial to prevent substantial mortality.

Congenital diplopodia-A rare case of duplicated lower limb: A case report.

INTRODUCTION AND IMPORTANCE: Diplopodia is an extremely rare case in medical history, with an even fewer cases being reported in literature. We intended to enrich the literature about diplopodia with our own case report. CASE PRESENTATION: We present a case about A boy, aged one year and four months old brought by his mother to the hospital with a chief complaint of a duplicated foot in his right lower leg. Physical examination demonstrated a normal left lower extremity and a relatively well-developed duplicate foot emanating from the posterior-lateral aspect of the mid-lower right leg. CLINICAL DISCUSSION: Diplopodia consists of partial duplication of the foot, with or without hypoplasia or positional abnormality of the ipsilateral tibia and fibula. It must be differentiated from polydactyly where the additional structures consist of toes that may or may not have corresponding metatarsals but are devoid of tarsal bone. Treatment should be considered case-by-case basis and tailored appropriately to suit individual needs and circumstances. CONCLUSION: In our case, operative treatment was done at an early walking age to provide plantigrade, functional foot. Timely surgical intervention will enable patient to adapt over time. The secondary aim is to reconstruct the foot to be more acceptable aesthetically.