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Multiple organ dysfunction syndrome (MODS) is a continuum, a process, with incremental degrees of physiologic derangement in individual organs; It is defined as a clinical syndrome characterized by the development of progressive and potentially reversible physiologic dysfunction in 2 or more organs or organ systems that is induced by a variety of acute insults.a
Acute kidney injury (AKI) is defined functionally as a rapid decline in glomerular filtration rate (GFR) that leads to accumulation of waste products such as blood urea nitrogen (BUN) and creatinine resulting in inability of the kidneys to maintain and sustain fluid and electrolyte homeostasis.1 The condition is often caused by a variety of factors ranging from a reduction in the intravascular volume typified by reduced renal perfusion, direct injury to the kidney itself to some obstructive conditions which can be congenital or acquired.
Clinical manifestations/presentations vary and are dependent on the original cause of the AKI. This study is an observational fallout from the AKI crisis that occurred in the 2nd half of the year 2022 in The Gambia.
Methods: This was an observational, cross sectional study of children attended to at the Edward Francis Small Teaching Hospital Banjul who presented with features of Multiple organ failure and AKI associated with ingestion of possibly contaminated syrups. Thorough history with physical examination were carried out, blood, urine, stool samples, with ingested drug samples were collected for laboratory and toxicological investigations while 2 autopsies were carried out.
Results were presented as proportions and associations assessed using fishers exact test. Level of significance was accepted as p<0.05.
Findings: Sixty-six patients were admitted for AKI, 41 (65.1%) were males and 22 (34.9%) females with a male female ratio of 1.0: 0.54. Age ranged between 2 months and 7 years with a mean of 21.9 ±17.3 mths. Oliguria or anuria was mostly the reason for referral with a mean duration of 4.03 ± 3.0 days prior to presentation/referral. The time interval between drug ingestion to the time of manifestation of oliguria/anuria was 1 to 6 days with a mean of 2.9 ±2.6 days and a mode of 3 days.
Level of consciousness varied widely with some showing various levels of altered sensorium with recorded episodes of tonic-clonic convulsions. Most 58(92.9%),were well hydrated, 25(39.7%) had respiratory distress and 14(22.2%) had some degree of pallor.
Most of the laboratory tests including Liver Function Test, Renal Function test, Uric acid levels, Full blood count were severely deranged.
Autopsy results in 2 of the victims showed evidence of Acute Tubular Necrosis, periportal and interstitial fibrosis with multi-focal hepatic cell necrosis, Pulmonary and splenic congestion.
Two (3.1) survived, 1(1.5) was discharged against medical advice (DAMA) and 63 died (95.4%) with 75% of the fatalities occurring in children less than 2yrs of age with a male predominance.
Conclusion: Evidence strongly suggests that mortality was associated with ingestion of contaminated liquid medications which had resulted in multi-organ failure with AKI