Mark G Williams1. 1. Department of Surgery, North Devon District Hospital, Barnstaple, United Kingdom.
Abstract
BACKGROUND: The aim of this study was to examine biochemical investigations not routinely performed prior to emergency laparotomy in patients at Queen Elizabeth Central Hospital, a low-resource public hospital in Blantyre, Malawi. METHODS: A prospective cross-sectional study of adults (N = 15) needing emergency laparotomy over a 4-week period were studied at Queen Elizabeth Central Hospital. Biochemical investigations, not routinely performed for economic reasons, were performed preoperatively; these included sodium, potassium, chloride, carbon dioxide, urea, and calcium levels. RESULTS: Gastrointestinal pathology was predominant among the emergency laparotomies performed. Large bowel obstruction and bowel perforation secondary to typhoid were most frequent. Clinically significant biochemical derangements among the study patients were as follows: cases of moderate-to-severe hypokalaemia (n = 2), severe hyponatraemia (n = 1), moderate hypernatraemia (n = 1), and severe hypocalcaemia (n = 1). The most frequent abnormalities seen were uraemia and hypochloraemia (n = 11). CONCLUSIONS: Accurate electrolyte estimation in critically ill preoperative patients is desireable for optimal perioperative management but frequently absent in resource-challenged environments.
BACKGROUND: The aim of this study was to examine biochemical investigations not routinely performed prior to emergency laparotomy in patients at Queen Elizabeth Central Hospital, a low-resource public hospital in Blantyre, Malawi. METHODS: A prospective cross-sectional study of adults (N = 15) needing emergency laparotomy over a 4-week period were studied at Queen Elizabeth Central Hospital. Biochemical investigations, not routinely performed for economic reasons, were performed preoperatively; these included sodium, potassium, chloride, carbon dioxide, urea, and calcium levels. RESULTS: Gastrointestinal pathology was predominant among the emergency laparotomies performed. Large bowel obstruction and bowel perforation secondary to typhoid were most frequent. Clinically significant biochemical derangements among the study patients were as follows: cases of moderate-to-severe hypokalaemia (n = 2), severe hyponatraemia (n = 1), moderate hypernatraemia (n = 1), and severe hypocalcaemia (n = 1). The most frequent abnormalities seen were uraemia and hypochloraemia (n = 11). CONCLUSIONS: Accurate electrolyte estimation in critically ill preoperative patients is desireable for optimal perioperative management but frequently absent in resource-challenged environments.
Authors: Jonathan C Samuel; Javeria S Qureshi; Gift Mulima; Carol G Shores; Bruce A Cairns; Anthony G Charles Journal: World J Emerg Surg Date: 2011-11-08 Impact factor: 5.469