RESUMO
BACKGROUND: In 2008, several Nigerian children developed acute kidney injury (AKI) after ingesting teething syrup contaminated with diethylene glycol (DEG). Because there are limited diagnostic facilities in resource-constrained countries, this study investigated whether AKI associated with DEG could be identified by other means. METHODS: This was a multicenter study. Information was obtained from hospital records. Clinicopathological features of all children with AKI over a 6-month period were reviewed. RESULTS: Sixty (50.4%) of 119 children ingested "My pikin" teething syrup. Compared to children who had not ingested it, they were significantly (p < 0.05) younger (11.95 vs. 31 months), more were anuric (98.3 vs. 74.6%), hypertensive (84 vs. 52%), had severe metabolic acidosis (46.7 vs. 20.5%), and died (96.6 vs. 71.2%). They developed increasing metabolic acidosis and multiorgan dysfunction despite peritoneal dialysis. Late presentation, financial difficulties, inadequate facilities for toxicology, and hemodialysis complicated management. CONCLUSIONS: Identifying AKI associated with DEG is difficult. Detailed drug history, increasing metabolic acidosis, and multiorgan deterioration despite peritoneal dialysis should arouse suspicion. Simple diagnostic tests need to be developed and facilities for hemodialysis of infants and financial support provided. Recurrences can be prevented by creating awareness, improving manufacturing practices, field-testing of drugs, and international monitoring of pharmaceuticals imported for manufacture.
Assuntos
Países em Desenvolvimento/economia , Contaminação de Medicamentos , Etilenoglicóis/intoxicação , Custos de Cuidados de Saúde , Testes de Função Renal/economia , Insuficiência Renal/diagnóstico , Acidose/induzido quimicamente , Acidose/diagnóstico , Analgésicos/química , Analgésicos/uso terapêutico , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Combinação de Medicamentos , Etilenoglicóis/análise , Feminino , Humanos , Lactente , Masculino , Anamnese , Insuficiência de Múltiplos Órgãos/induzido quimicamente , Insuficiência de Múltiplos Órgãos/diagnóstico , Nigéria/epidemiologia , Intoxicação/diagnóstico , Intoxicação/economia , Intoxicação/etiologia , Valor Preditivo dos Testes , Prognóstico , Diálise Renal/economia , Insuficiência Renal/induzido quimicamente , Insuficiência Renal/economia , Insuficiência Renal/epidemiologia , Insuficiência Renal/terapia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Erupção Dentária/efeitos dos fármacosRESUMO
OBJECTIVES: Diarrhoeal diseases (DDs) constitute public health problem. Reduction in related mortality and morbidity hinges on active participation of home caregivers. It is pertinent to determine the degree of their empowerment. DESIGN: Cross-sectional study. SETTING: Randomly selected community primary health centres in northwestern Nigerian. SUBJECTS: Home caregivers presenting with children aged 1-59 months having DD. OUTCOME MEASURES: Knowledge, attitude and practice regards home management of DD. RESULTS: Less than 1% of caregivers was knowledgeable about home management of DD. Antibiotics and anti-diarrhoeal agents use was common at 36%. ORS use was abysmally low at 8.6%. Only 32% of caregivers were aware of the use of zinc in the management of DD. Adherence to 10-day zinc supplementation was encouraging at 75.5%. CONCLUSION: There is an urgent need to scale up educational and promotional activities with regards to the home management of DD if the millennium development goals are to be met.
