Daily Independent (Lagos)
Yinka Shokunbi
10 December 2008
For about a month the authorities at the Lagos State University Teaching Hospital, LASUTH, (among four other tertiary hospitals) were challenged by the sudden epidemic of Acute Renal Failure (ARF) among children in the State as a result of the ingestion of various drugs suspected to have been contaminated with diethyleneglycol. A total of 18 children were treated at the facility. Some underwent dialysis, others were referred but all died because nothing much could be done to save their situation. Assistant Editor, YINKA SHOKUNBI, spoke with Head of Department Pediatrics, Dr. Elizabeth Disu, and Consultant Pediatric Nephrology, Dr. Segun Gbelee, and in this essay summarised their agonies as they relayed how children died helplessly, regardless of efforts to save them.
Nothing in the wild of dreams had prepared the Pediatrics Department of the Lagos State University Teaching Hospital (LASUTH) for the experience the doctors went through in the past few weeks, since the outbreak of the epidemic of Acute Renal (Kidney) Failure, which killed 18 children in the hospital.
Although it is not unusual for the Pediatricians to see so many children, after all, that is why the clinic is for children. What, perhaps, they have not been used to is a sudden outbreak of an epidemic that would claim lives of children in droves, regardless of medical interventions.
That, at least, was the lot that faced Head of Pediatric Department, Dr. Elizabeth Disu, and Consultant Pediatric Nephrology, Dr. Olusegun Gbelee, who along with other doctors at the teaching hospital had to battle for several days to rescue the lives of about 18 children from the throes of death, a battle they eventually lost in spite of their sleepless days and medical trials.
The children were among several others who due to ill-health had allegedly been administered with drugs ranging from Anti-malarials, Paracetamol, Cough Syrups and a suspected Killer Teething Mixture, My Pikin, which eventually led to their developing Acute Kidney Failure and then, death.
"It's been very sad and quite hectic as well; most especially at the point when we began to get some support from government and the hospital to start dialysing the children," noted Disu, who recalled how the entire episode has drained both human and material resources "within a short while."
The hospital had to recall Dr. Gbelee, who was already on vacation, "because we needed to put all hands on the deck to save these children, who were arriving in numbers," she told Daily Independent.
"Unfortunately, all our efforts (at dialysis) didn't even help because among those that we tried to save with the dialysis, a few of them responded initially with urine but it wasn't sustained and they all succumbed (died). So, it's really a very pathetic, very sad situation that we had and it actually drained a lot of energy from us as well as resources," noted Disu.
Wondering how it all began for the medical team at LASUTH's Pediatric Clinic, Disu explained that it was during the usual departmental morbidity meeting, a review exercise of events and causalities, held on November 19 that attention was drawn to the rising profile of children with Acute Renal Failure (ARF) since the beginning of November.
According to Disu, "By November 19, we had seen a disproportionately higher number of ARF than what we had been seeing in the past and that made us raise an alarm and try to inform the authority about this. Just coincidently, it had become public notice as well and we realised others were seeing what we had seen."
The LASUTH experience was indeed worrisome to the pediatric team as the hospital's previous records of children with kidney diseases had never been near half of the harvested incidence in the present episode.
Recalling previous experience, Gbelee told our correspondent, "Hitherto, we saw not more than five to eight cases annually. And, of course, these were cases that had previous diagnosis and had progressed to terminal end but in this current episode, the cases were acute and presented with sudden end stage renal diseases.
When we started seeing five within a week, it suggested that something was not right," Gbelee pointed out.
From the available hospitals' medical records of some of the children, Daily Independent discovered that their ages ranged between four months to 11 years, which is an indication that not all the children had taken doses of the alleged killer My Pikin "as many of them were far above teething age," observed Disu.
The medical report on 14 of the dead children showed that nine of them had been administered with various brands of Paracetamol in addition to My Pikin and other drugs by their parents over a period of time before they were brought to the Teaching Hospital.
This, Disu explained, is a common phenomenon. "Paracetamol is a common household drug, which almost every household has and they use quite frequently, so much that if anything is happening in its ingestion, you may not notice quickly unless a large number of incidences occur too frequently and are presented within a short time, as what had happened in this case."
Also, common among the children, who came to the children's emergency room, were vomiting, watery stools (diarrhea), fever, and inability to make urine, difficulty in breathing, swellings or blotting as well as cough.
These presentations, according to Gbelee, are phenomena common to patients with renal failure.
"You see, the basic principle of the function of the kidneys is removing wastes and water from the blood. The kidneys also help balance chemicals in the body as well as help in releasing hormones, among other functions.
"Now, there was an ingestion of suspected diethyleneglcol, which is anti-freeze used in the industry, and the effect of the ingestion is that it damaged the kidneys, so that they failed to perform their functions. So, if wastes are not coming as they should, they cause toxic effect on the body organs called urea, a form of protein waste produced by the body and passed out through the kidneys in the urine. And when the kidneys failed to filter this urea, other body organs like the lungs and brain of the children were affected. They ended up with multi-organ failure, which is usually the basis for Peritoneal Dialysis," explained Gbelee.
The principle of peritoneal dialysis is to infuse Dialysis Fluid (clean) in the child's abdomen through a small tube, similar to function of the kidney's renal artery, after a certain amount of time, it is drained through the same tube, removing with it the waste products.
"What we were trying to do in this way," Gbelee said, "is just to dilute the concentration of urea in the blood through washing.
"Luckily, few of them started making urine, but at the end, we still lost them. So, our experience showed that the episode was largely dependent on the level of toxicity, which is different from what we see normally, even as the damage was the same," he said.
What particularly baffled the Pediatricians was the fact that some of the children who were above teething age and who did not consume the alleged Killer Mixture but ingested other brands of Paracetamol, Cough Syrups and doses of Anti-malarial also manifested symptoms of kidney failure like those who ingested My Pikin and subsequently died from kidney complications.
Noted Disu, "There is a point I would like to raise and that is, the fact that we should not limit ourselves to look at just a particular drug because we had children, who never heard about that drug and yet they came in with the problem.
"Some of them had other brands of Paracetamol Syrups, some took Paracetamopl tablets. We even had the case of an 11-year old, whom we were treating for cerebral malaria, but later died of ARF. We couldn't really pick at what point she developed this because she was given Paracetamol tablet and not My Pikin, Disu added.
The duo, Disu and Gbelee, however, warned about rising incidence of self-medication not just with orthodox drugs but also with herbal preparations, "which no serious analysis have been carried out by the authorities."
From observations, experts noted that so many herbal preparations have been prepared, mixing orthodox drugs to give "extra effects."
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