The Utility Of Base Deficit And Serum Lactate As Predictors Of Outcome In Patients With Intestinal Obstruction At Kenyatta National Hospital

Abstract

Background Intestinal Obstruction is a key cause of morbidity and mortality among all age groups. Diagnosis and treatment of intestinal obstruction is key in preventing adverse outcomes. Metabolic derangements as well as intestinal ischemia are common complications of intestinal obstruction. Base Deficit and serum lactate are markers of inadequate perfusion status. They have also been used to predict complications and mortality especially in truama patients. Objective To assess utility of initial base deficit and serum lactate as predictive indicators of adverse outcomes in intestinal obstruction. Methodology This was a prospective descriptive study evaluating 54 patients,carried out in the general and paediatric surgical units, Kenyatta National Hospital, Nairobi Kenya. Consecutive patients aged 1month and above, presenting with intestinal obstruction to the Kenyatta Nation Hospital Accident & Emergency (A&E) department were recruited. The patients’ demographic and clinical data were obtained using a structured questionnaire. Initial arterial blood gas and serum lactate results were compared against patient outcomes. Data was analysed using a level of significance P<0.05 Results The average age of the patients was 27 (SD=23) years, with 74% of them being males. The most common presentations were abdominal distension (87%), vomiting (79.6%), constipation (44%) and pain (37%). The most common cause of instestinal obstruction were instusussception (31.5%) and adhesions due to previous surgery (24%). Mortality was (16.7%) while morbidity was (12.9%). The prevalence of derangements of base deficit was 64.8% and of serum lactate 27.8% on admission. There was no significant relationship (P = 0.633) between base deficit and adverse outcome nor was there any statistical significance (P = 0.072) between serum lactate and adverse outcome in intestinal obstruction. There was no correlation between the initial base deficit, initial serum lactate levels and adverse outcome in patients with intestinal obstruction . Conclusion The initial base deficit and serum lactate levels did not have a bearing on the probability of developing adverse outcomes in patients admitted with a diagnosis of intestinal obstruction.