Propofol Induced Hyperkalemia and Its Management in End Stage Renal Disease Patients.

Propofol related infusion syndrome (PRIS) is a rare, but extremely dangerous complication of propofol administration. Unexplained anion-gap metabolic acidosis, rhabdomyolysis, hyperkalemia, acute kidney injury, elevated liver enzymes, and potentially fatal cardiac arrhythmias are characteristic of PRIS. Risk factors for the develop- ment of PRIS include dose and duration of propofol infusion, severe illness, and concomitant administration of catecholamine and glucocorticoids. PRIS causing hyperkalemia is a well-known clinical entity. Although the development of PRIS depends on the duration and total amount of drug infused, repeated boluses of propofol, commonly used for rapid sequence intubation and conscious sedation, can potentially precipitate fatal hyperkalemia. This is of particular concern in advanced chronic kidney disease (CKD) and end stage renal disease (ESRD) patients. We report a case of a propofol induced hyperkalemia causing near fatal cardiac arrhythmia in a dialysis dependent ESRD patient. We report successful revival from cardiac arrest by intensive calcium regimen and hemodialysis. This case highlights underrecognized problem of propofol-induced hy- perkalemia, which can be of particular concerns in advanced CKD and ESRD.

The impact of a single surgical intervention for patients with a cleft lip living in rural Ethiopia.

BACKGROUND: Humanitarian organisations commonly provide reconstructive treatment for patients with cleft lip within developing countries, but follow-up is often non-existent, particularly for those living in rural areas. This study aimed to assess whether a single surgical intervention was sufficient to produce an observable change to the life of a patient with cleft lip living in rural Hararghe in eastern Ethiopia. METHODS: 356 patients with isolated cleft lips, who received a single surgical treatment at least 6 months previously, were evaluated in 21 rural health centres. RESULTS: Patients and their families expressed unhappiness before treatment, mainly because the society reacted negatively towards the deformities, isolating the patients from community activities. Postoperatively, the percentage of school-aged children participating in education increased from 46% to 79%, some older patients were able to marry, but employment was unaffected. The prevalence of wound dehiscence in the lip repair was 3% and occurred more frequently in patients with a bilateral cleft lip compared to a unilateral cleft lip (p < 0.001, RR 49.25, 95% CI 6.7-1037.35). CONCLUSIONS: We demonstrated that follow-up can be achieved by charitable organisations treating rural patients and that the majority of patients report a positive impact following surgical intervention. We recommend that bilateral cleft lips have a more intense rural aftercare.

Maternal risk factors for childhood anaemia in Ethiopia.

A total of 8260 children between the ages of 6-59 months were analyzed to identify the risk factors associated with childhood anaemia in Ethiopia. The overall mean (SD/standard deviation) haemoglobin (Hgb) level among the under-five children was 10.7 (2.2) g/dl and 50.3% were anaemic. Childhood anaemia demonstrated an increasing trend with maternal anaemia levels of mild, moderate and severe anaemia: odds ratio of 1.82, 2.16 and 3.73 respectively (p< 0.01). Children whose mothers had no formal education were 1.38 times more likely to be anaemic (p<0.01). The poorest and poorer wealth index groups had 1.52 and 1.25 increased odds of childhood anaemia respectively (p< 0.01). Childhood anaemia in Ethiopia is a severe public health problem. Maternal anaemia and socio-economic status were found to be associated with anaemia in children. A holistic approach of addressing mothers and children is of paramount importance.