Occurrence of adverse drug reactions associated with highly active anti-retroviral therapy at Mbagathi District Hospital, Nairobi, Kenya

Background: Life-saving highly active anti-retroviral therapy (HAART) has been accompanied by the challenge of incident adverse drug reactions (ADRs). Locally generated data is scanty, inadequately documented, and therefore not available to inform revision of clinical protocols.Objective: To study and document the magnitude and type of ADRs associated with HAART over a 42 month period at Mbagathi District Hospital (MDH) Nairobi.Design: A retrospective cohort study.Setting: A high burdened HIV comprehensive care clinic based at the Mbagathi District Hospital in Nairobi, Kenya.Subjects: HIV infected patients receiving highly active anti-retroviral therapy (HAART)Results: Adverse drug reactions associated with HAART occurred in 63% of adult study subjects. Majority (91.4%) of the ADRs experienced were medium to long term conditions, namely peripheral neuropathy in 33.3%, lipodystrophy in 32.6%, hepatic toxicity in 24.4% and lactic acidemia in 4.1 % of patients. Furthermore, occurrence of all the ADRs was associated with increasing baseline age (p<0.0001). Gender differences were found in patients with lipodystrophy (p<0.001), and lactic acidemia (p=0.047),with a female preponderance.Conclusion: Adverse drug reactions were experienced by 63% patients on HAART. Majority of the ADRs were those commonly associated with the medium to long term use of stavudine and nevirapine. Despite the high frequency of ADRs, patient outcomes were favourable as there were no reported deaths or hospitalisations

Clinical features, predictive factors and outcome of hyperglycaemic emergencies in a developing country

<p>Abstract</p> <p>Background</p> <p>Hyperglycaemic emergencies are common acute complications of diabetes mellitus (DM) but unfortunately, there is a dearth of published data on this entity from Nigeria. This study attempts to describe the clinical and laboratory scenario associated with this complication of DM.</p> <p>Methods</p> <p>This study was carried out in DM patients who presented to an urban hospital in Nigeria with hyperglycaemic emergencies (HEs). The information extracted included biodata, laboratory data and hospitalization outcome. Outcome measures included mortality rates, case fatality rates and predictive factors for HEs mortality. Statistical tests used are <it>χ</it>², Student's t test and logistic regression.</p> <p>Results</p> <p>A total of 111 subjects with HEs were recruited for the study. Diabetes ketoacidosis (DKA) and hyperosomolar hyperglycaemic state (HHS) accounted for 94 (85%) and 17 (15%) respectively of the HEs. The mean age (SD) of the subjects was 53.9 (14.4) years and their ages ranged from 22 to 86 years. DKA occurred in all subjects with type 1 DM and 73 (81%) of subjects with type 2 DM. The presence of HSS was noted in 17 (19%) of the subjects with type 2 DM.</p> <p>Hypokalaemia (HK) was documented in 41 (37%) of the study subjects. Elevated urea levels and hyponatraemia were noted more in subjects with DKA than in those subjects with HHS (57.5%,19% vs 53%,18%). The mortality rate for HEs in this report is 20% and the case fatality rates for DKA and HHS are 18% and 35% respectively.</p> <p>The predictive factors for HEs mortality include, sepsis, foot ulceration, previously undetected DM, hypokalaemia and being elderly.</p> <p>Conclusion</p> <p>HHS carry a higher case fatality rate than DKA and the predictive factors for hyperglycaemic emergencies' mortality in the Nigerian with DM include foot ulcers, hypokalaemia and being elderly.</p

Diabetic ketoacidosis: clinical presentation and precipitating factors at Kenyatta National Hospital, Nairobi

Objective: To determine the clinico-laboratory features and precipitating factors of diabetic ketoacidosis (DKA) at Kenyatta National Hospital (KNH). Design: Prospective cross-sectional study. Setting: Inpatient medical and surgical wards of KNH. Subjects: Adult patients aged 12 years and above with known or previously unknown diabetes hospitalised with a diagnosis of diabetic ketoacidosis. Results: Over a nine month period, 48 patients had DKA out of 648 diabetic patients hospitalised within the period, one died before full evaluation. Mean (SD) age was 37 (18.12) years for males, 29.9 (14.3) for females, range of 12 to 77 years. Half of the patients were newly diagnosed. More than 90% had HbA1c >8%, only three patients had HbA1c of 7-8.0%. More than 90% had altered level of consciousness, with almost quarter in coma, 36% had systolic hypotension, almost 75% had moderate to severe dehydration. Blunted level of consciousness was significantly associated with severe dehydration and metabolic acidosis. Over 65% patients had leucocytosis but most (55%) of them did not have overt infection. Amongst the precipitating factors, 34% had missed insulin, 23.4% had overt infection and only 6.4% had both infection and missed insulin injections. Infection sites included respiratory, genito-urinary and septicaemia. Almost thirty (29.8%) percent of the study subjects died within 48 hours of hospitalisation. Conclusion: Diabetic ketoacidosis occurred in about 8% of the hospitalised diabetic patients. It was a major cause of morbidity and mortality. The main precipitant factors of DKA were infections and missed insulin injections. These factors are preventable in order to improve outcomes in the diabetic patients who complicate to DKA. East African Medical Journal Vol. 82(12) 2005: S191-S19