Steroid-induced diabetic ketoacidosis in a 14-year-old boy with steroid-sensitive nephrotic syndrome: Case report and literature review.

In this report, we described the case of a 14-year-old boy with steroid-sensitive nephrotic syndrome who developed hyperglycaemia and ultimately, diabetic ketoacidosis, following high-dose steroid therapy for a primary renal disease. The nephrotic syndrome was diagnosed based on generalized oedema, massive proteinuria, hypoalbuminaemia and hypercholesterolaemia. Serum creatinine and random blood glucose levels were normal and there was no glycosuria. He was commenced on high dose prednisolone 40 mg 12 hourly and by the 8th day on prednisolone, he achieved remission and was discharged. However, four weeks later, he developed features of diabetic ketoacidosis (DKA) which was confirmed by the presence of hyperglycaemia (random blood glucose19.4 mmol/L), acidosis (serum bicarbonate 10 mmol/L) and ketonuria (2+). The DKA was managed with intravenous fluid (0.9% sodium chloride), continuous insulin infusion and antibiotics. After resolution of the DKA, he was switched to subcutaneous soluble insulin and thereafter, premixed insulin twice daily with a reduction in the dose of prednisolone and was discharged home after 30 days on admission. Blood glucose level has remained within normal range one year after discontinuing insulin and he is still in remission with regard to the nephrotic syndrome at follow up.Conclusion: The risk of diabetic ketoacidosis should be considered in the course of steroid therapy for nephrotic syndrome. To avoid missing of cases of steroid-induced diabetes mellitus, and ultimately DKA, both fasting and postprandial blood glucose values should be monitored.Key words: Adolescence, diabetes, ketoacidosis, nephrotic syndrome, steroid therapy

Blood pressure percentiles in a group of Nigerian school age children

Background: Determination of abnormal blood pressure (BP) in children is dependent on comparison with normal percentile values. The commonly used National Institute of Health (NIH) standard is generated from childrenoutside of Africa.Objective: To develop BP percentile values for Nigerian childrenbased on BP cuff width 40% to 50% of arm circumference.Methods: Subjects were pupils from nine primary schools in Midwestern Nigeria recruited using a multi-stage sampling technique. Their BP was measured using a cuff width of 40 to 50% of arm circumference and cuff length of at least 80% of arm circumference respectively. The mean of two BP readings were taken. Hypertension was defined as systolic and or diastolic BP >95th percentile of the study population.Results: There were 1549 subjects, aged 5 to 15 years, of which 757 (48.9%) were males. Prevalence of hypertension was 2.6%. Only age and weight were independent predictors of both elevated systolic and diastolic BP. The 5th, 10th, 50th, 90th and 95th percentiles of Systolic and diastolic BP were generated for both males and females pupils.Conclusion: BP Percentiles have been generated using BP cuff width 40 to 50% of the arm circumference for Nigerian children.Keyword: Blood pressure; hypertension; childhood; percentil

Evaluation of Feeding Practice and the Use of Home-made and Food-based fluids during diarrhea episodes by mothers in Benin-City

Background: Oral Rehydration Therapy, which includes the use of home-made, food-based fluids helps to prevent diarrhoeal dehydration. Information on the knowledge of the use of these home-made food-based fluids appears scanty, hence the need to evaluate the current status of maternal knowledge on the use of these fluids during diarrhoeal episodes.Methods: This cross-sectional study was carried out in two major hospitals in Benin City, Edo State. Subjects were mothers of children presenting with diarrhoea.Results: Out of the 104 mothers, only 47(45.2%) said the child should be fed frequently during episodes of diarrhoea. Only 7(6.7%) mothers agreed that garri water could be used. Nine (8.7%) and 6(5.8%) mothers agreed that green coconut water and boiled rice water could be used respectively.Conclusion: Majority of the mothers had no knowledge of the use of home-made fluids during diarrhoeal episodes in children. This is a dangerous trend which may worsen diarrhoea mortality.Key words: Diarrhoea, home-made food-based fluids, feeding practice

Knowledge of proper preparation of salt sugar solution (SSS) by Mothers of children presenting with diarrhoea in Benin City

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Anaemia in HIV infected Nigerian children on HAART

Background: Most studies evaluating anaemia and associated factors in HIV infected children have been done on those that are HAART naïve. This study evaluated anaemia among Nigerian children on HAART.Methodology: This cross-sectional study estimated Packed Cell Volume (PCV) in 155 HIV infected children attending an HIV treatment programme. Data on age, gender, CD4 counts, CD4 percentage in those younger than 5years and tuberculosis status were obtained. Their urine was tested for microalbuminuria.Results: Of the 155 children 91(58.7%) were males. The mean age was 6.9±3.8years. The mean PCV was 33.2±3.4%. Anaemia(PCV<33%) was present in 63(40.7%). No child had severe anaemia(PCV<15%). Presence of microalbuminuria was significantly associated with anaemia. P=0.02. Anaemia was not associated with age, gender, CD 4percentage, CD4 count, presence of tuberculosis and use of Zidovudine containing HAART regimen.Conclusion: Anaemia remains a significant problem even in HIV infected children on HAART. Regular monitoring is indicated. Investigation of anaemia in these children should include screening for renal disease

Characteristics of Nigerian Children With Human Immunodeficiency Virus and Tuberculosis Coinfection

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Superiority of cystatin c to creatinine as a biomarker of kidney function: two case studies and review of the literature.

Creatinine is the most commonly used endogenous substance in the estimation of glomerular filtration rate (GFR) but it is inaccurate being influenced by body mass indices, tubular secretion and extrarenal elimination. Conversely, cystatin C is superior to creatinine as a marker of kidney function. We recently managed two children who had major risk factors for chronic kidney disease (CKD) but had serially apparently normal serum creatinine levels. However, using a cystatin C-based method, they were already in CKD stage 2. Cystatin C is a promising alternative to creatinine for routine clinical use in our setting, enabling accurate and early detection of CKD in children.Key words: cystatin C, creatinine, glomerular filtration rates