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[Characteristics of peritoneal fluid in children with severe diarrhea]
1Hospital de Especialidades 1, Centro Médico Nacional Noroeste, Instituto Mexicano del Seguro Social, Ciudad Obregón, Sonora. lllaex@infosel.net.mx
Insights
Peritoneal fluid analysis aids in diagnosing severe diarrhea complications. Clear, yellow fluid with specific cell counts, glucose, and chloride levels indicates no irreversible bowel injury, improving patient outcomes.
Area of Science:
- Gastroenterology
- Surgical Diagnostics
- Medical Laboratory Science
Context:
- Acute diarrheal diseases can cause severe bowel wall damage, potentially leading to fatal outcomes.
- Early diagnosis of bowel injury is crucial for effective patient management.
- Peritoneal fluid (PF) analysis is explored as a diagnostic tool for acute diarrheal complications.
Purpose:
- To evaluate the diagnostic utility of peritoneal fluid analysis in patients with acute diarrhea and suspected enteric perforation or gangrene.
- To determine the sensitivity, specificity, and predictive values of PF characteristics in identifying bowel wall injury.
Summary:
- Paracentesis was performed on 30 patients with acute diarrhea and suspected enteric perforation/gangrene.
- PF analysis included visual inspection (color), leukocyte count, protein, glucose, and chloride levels.
- Clear, yellow PF with specific biochemical parameters indicated absence of irreversible bowel injury, while bloody PF or elevated leukocytes suggested significant damage.
Impact:
- PF analysis provides valuable insights for evaluating children with severe diarrhea and suspected enteric perforation or gangrene.
- Specific PF parameters (color, leukocytes, glucose, chloride) can help differentiate between reversible enteritis and irreversible bowel wall injury.
- Accurate early diagnosis through PF analysis can guide timely surgical intervention and improve patient prognosis.
Background:
A significant number of acute diarrheal diseases produce severe damage to the bowel wall that can lead the patient to death. Peritoneal fluid (PF) analysis has been proposed as a tool to establish an early diagnosis of these injuries.
Material And Method:
Thirty patients with a diagnosis of acute diarrhea and suspected enteric perforation or gangrene were submitted to paracentesis. LP was classified according to its appearance immediately after obtention by the surgeon, and determinations of leukocytes, proteins, glucose, and chloride were done. Clinical diagnosis was established during laparotomy or necropsy, or after an uneventual recovery. Data were analyzed by means of diagnostic test statistics.
Results:
Clear and yellow PF was considered a sign of the absence of enteric perforation or gangrene, with a sensitivity (S) of 87%, specificity (SP) and positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 91.6%, with a predictive accuracy (PA) of 95%. A bloody PF was considered a sign of enteric gangrene, with an S of 54%, SP and PPV of 100%, and NPV of 72% (PA 80%). More than 1000 leukocytes per mm3 of PF were considered an sign of some kind of macroscopic injury of the bowel wall, with an S of 68%, a SP of 88%, a PPV of 91% and a NPV of 61% (PA 76%). PF glucose level less than 40 mg/dl was considered a sign of enteric gangrene (S 42%, SP 78%, PPV 71%, NPV 50%, with a PA of 57%), and also of bacteria viability in PF cultures (S and NPV 100%, SP 80%, PPV 67% and PA of 86%). Chloride levels greater than 90 meq/L were considered a sign of enteric perforation or gangrene, with an S and NPV of 100%, a SP of 60%, and a PPV de 82% (PA 86%).
Conclusion:
PF analysis is of great value in the evaluation of the child with acute severe diarrhea in which enteric perforation or gangrene is suspected. A clear yellow fluid with less than 1000 leukocytes per mm3, more than 40 mg/dL of glucose, and less than 90 meq/L of chloride suggest that enteritis has not caused irreversible injury to the bowel wall.