No abstract

Introduction: Dengue is the most rapidly spreading mosquito-borne viral disease. Liver is the most commonly affected organ and manifests as asymptomatic transaminitis to acute liver failure. Aim: (1) To study the clinical and biochemical profile of liver involvement. (2) To find the association between severity of hepatic dysfunction, morbidity and mortality in the admitted patients. Method and Material: This was a prospective study involving confirmed dengue fever cases admitted in Tata Main Hospital from January 2018 to December 2019. Cases were classified into non-severe dengue and severe dengue based on 2009 WHO classification. Severity of hepatic dysfunction was divided into grades A, B, C and D and correlation with various outcomes which included length of stay, complications and mortality was studied through relevant investigations. Results: Out of the 175 cases, Non-severe Dengue (NSD) was seen among 72.6% patients while severe dengue (SD) in 28.5% patients. Normal liver function was found in 68.6%, Grade B liver injury in 8% while Grade C and Grade D liver injury in 16.6% and 16.8% patients respectively. Mean AST levels were found to be higher than those of ALT levels. Longer hospital stay, complications like shock, acute kidney injury (AKI), thrombocytopenia and mortality were significantly more in patients with higher grades of liver dysfunction (p=0.03), while ARDS and MODS were seen only in patients with Grade C and Grade D liver injury. Conclusion: AST and ALT levels were statistically higher in Dengue fever patients with worse outcome. They can thus, serve as prognostic markers of severe Dengue.

Patients of chronic alcohol abuse can present with a variety of acid-base disorders and electrolyte disturbances. Lactic acidosis (LA) along with alcoholic ketoacidosis is an infrequent and underappreciated cause of wide anion-gap metabolic acidosis in alcoholic patients. The likelihood of misdiagnosing the condition is high because of the lack of awareness and presence of nonspecific clinical signs and symptoms shared with other clinical abnormalities such as acute pancreatitis, methanol or ethylene glycol poisoning, and diabetic ketoacidosis, which exist in these patients. As this condition is reversible with early intervention, promptly recognizing the condition and initiating proper treatment by the physicians would go a long way in preventing the morbidity and mortality in these patients. The outcome for such patients is excellent with early intervention. We report a patient with history of chronic alcoholism and alcohol binge admitted to the emergency department with triple acid-base disorder, which included life-threatening high anion-gap metabolic acidosis owing to concomitant LA and alcohol-related ketoacidosis in which the primary element was LA along with metabolic and respiratory alkalosis.