Life-threatening lithium-induced diabetes insipidus after colonic surgery

Colonic surgery is associated with major disturbances to patients’ fluid balance as aresult of pre-operative starvation, intra-operative blood loss, insensible losses, andpost-operative ‘third space’ losses. In the post-operative period, junior surgeons arewell trained to manage oliguria, but have little experience of the management ofpost-operative polyuria. Nephrogenic diabetes insipidus occurs in 12% of patientson lithium therapy and may present in the immediate post-operative period withmassive polyuria, profound dehydration and life threatening hypernatraemia, aspatients are unable to ingest large volumes of fluid orally. We report two cases, onelife threatening, of lithium induced nephrogenic diabetes insipidus (LINDI) whichpresented in the early postoperative period after emergency colonic surgery whilstthe patients were denied oral intake. The first patient attained a peak serum sodiumconcentration of 185mmol/l and required ventilation after a respiratory arrest. Wesuggest any surgical patient who describes a history of bipolar disorder or lithiumtherapy should be questioned directly to ascertain confirmatory features of LINDI,and have post-operative polyuria treated with aggressive fluid replacement

Life-threatening lithium-induced diabetes insipidus after colonic surgery: a report of two cases

Colonic surgery is associated with major disturbances to patients’ fluid balance as a result of pre-operative starvation, intra-operative blood loss, insensible losses, and post-operative ‘third space’ losses. In the post-operative period, junior surgeons are well trained to manage oliguria, but have little experience of the management of post-operative polyuria. Nephrogenic diabetes insipidus occurs in 12% of patients on lithium therapy and may present in the immediate post-operative period with massive polyuria, profound dehydration and life threatening hypernatraemia, as patients are unable to ingest large volumes of fluid orally. We report two cases, one life threatening, of lithium induced nephrogenic diabetes insipidus (LINDI) which presented in the early postoperative period after emergency colonic surgery whilst the patients were denied oral intake. The first patient attained a peak serum sodium concentration of 185mmol/l and required ventilation after a respiratory arrest. We suggest any surgical patient who describes a history of bipolar disorder or lithium therapy should be questioned directly to ascertain confirmatory features of LINDI, and have post-operative polyuria treated with aggressive fluid replacement

Editorial: Percutaneous endoscopic sigmoidopexy: a cost-effective means of treating sigmoid volvulus in sub-Saharan Africa?

No Abstract. The East African Medical Journal Vol. 84 (1) 2007: pp. 1-

Who is more accurate in the diagnosis of neck of femur fractures, radiologists or orthopaedic trainees?

OBJECTIVE Our study aims to compare the sensitivity and specificity between orthopaedic trainees and radiologists in diagnosing occult hip fractures from pelvic radiographs. METHODS All patients undergoing computed tomography (CT) of the hip for a suspected occult hip fracture at our two centres between November 1, 2010 and October 31, 2011 were retrospectively identified. Two orthopaedic trainees (RJ and ED) independently reviewed the initial radiographs, and if both agreed a fracture was present this was recorded. The reports from the radiologist of the initial radiograph and subsequent CT were recorded, with the CT report used as the standard of reference for comparison of performance. RESULTS 239 CTs were performed for suspected neck of femur fractures during the study period, compared to only 20 in 2006-07, reflecting a 1,095 % increase. The interpretation of radiographs by the orthopaedic trainees showed a sensitivity of 55.4 % and specificity of 96.6 %. In comparison, the radiologists had a sensitivity of 60.7 % and specificity of 92.9 %; this difference was shown not to be statistically significant. Radiologists and orthopaedic trainees agreed when interpreting the majority of radiographs with a Kappa co-efficient of 0.77 (a statistical measure of inter-rater agreement). In 20 of the 174 cases (11.5 %) where the radiologist and orthopaedic trainees agreed no fracture was present, the subsequent CT revealed a fracture. CONCLUSION Orthopaedic trainees and radiologists have similar accuracy at interpreting pelvic radiographs for suspected hip fractures, so the trainee's opinion can be relied upon. If uncertainty exists, then either the orthopaedic trainee or radiologist should request further imaging urgently as we believe this will expedite diagnosis and treatment of hip fractures, and ensure judicious use of CT

Total laparascopic hysterectomy at The Aga Khan University Hospital, Nairobi

No Abstract. East African Medical Journal Vol. 84 (11) 2007: pp.508-51

Nicorandil Induced Perianal Ulceration

Nicorandil is a cardioprotective drug which is used in the prophylaxis and long-term treatment of angina pectoris. Debilitating perianal ulcer is a rare complication of Nicorandil therapy which can cause diagnostic and management dilemmas. We describe the management of a case of Nicorandilinduced perianal ulcer and review pertinent contemporary literature. Key Words: cardioprotection, ischaemia, Nicorandil, perianal ulce