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British Journal of Healthcare and Medical Research - Vol. 10, No. 2
Publication Date: April 25, 2023
DOI:10.14738/jbemi.102.14467.
Ajite, A., Ogundare, E., Oluwayemi, I., & Adebisi, O. (2023). Alcohol Induced Acute Kidney Injury in A 13-Year-Old Nigerian Boy; A
Case Report. British Journal of Healthcare and Medical Research, Vol - 10(2). 432-438.
Services for Science and Education – United Kingdom
Alcohol Induced Acute Kidney Injury in A 13-Year-Old Nigerian
Boy; A Case Report
Adebukola Ajite
Department of Paediatrics, Ekiti State University,
Ado Ekiti, Ekiti State, Nigeria, and Department of Paediatrics,
Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
Ezra Ogundare
Department of Paediatrics, Ekiti State University,
Ado Ekiti, Ekiti State, Nigeria, and Department of Paediatrics,
Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
Isaac Oluwayemi
Department of Paediatrics, Ekiti State University,
Ado Ekiti, Ekiti State, Nigeria, and Department of Paediatrics,
Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
Olufemi Adebisi
Department of Paediatrics,
Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
ABSTRACT
Alcohol misuse has been insinuated to be a cause of acute kidney injury with various
patho-mechanisms suggested. We present a case of a 13-year-old Nigerian boy who
was admitted on account of vomiting of 4 episodes of 24 hours duration, convulsion
of several episodes within 3hrs prior to presentation and associated loss of
consciousness. He was apparently well until the outset of symptoms which were
preceded by ingestion of about 250mls of ‘LORDS’ dry gin containing 43% alcohol
mixed with Cocacola.The urinary output was 0.67mls/kg/hr on the first day of
admission while the peak serum creatinine value was 1425.2μmol/l. The random
blood sugar at admission was 14mmol/l. He was given intravenous fluid 5%
Dextrose /saline, intravenous phenytoin, diazepam 5mg, and antibiotic. He had 2
sessions of haemodialysis within 48 hours apart. Subsequently, he regained full
consciousness after the first session of dialysis and the creatinine level at discharge
was 73μmol/l with urine output of 1.67ml/min/hr. He was co-managed with the
Psychiatrist and the duration of admission was 16 days. He is being followed up
after discharge at the Paediatric nephrology clinic.
Keywords: alcohol, acute kidney injury, teenager, haemodialysis
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Ajite, A., Ogundare, E., Oluwayemi, I., & Adebisi, O. (2023). Alcohol Induced Acute Kidney Injury in A 13-Year-Old Nigerian Boy; A Case Report.
British Journal of Healthcare and Medical Research, Vol - 10(2). 432-438.
URL: http://dx.doi.org/10.14738/jbemi.102.14467.
INTRODUCTION
In the United States, alcohol use disorder is considered a public health challenge affecting 15 .7
million people of age ≥12 years [1]. The link between alcohol use disorder and kidney injury
has been controversial and this is mainly because there is inconclusive experimental evidence
to this effect [2]. However, alcohol misuse has been insinuated to be a cause of acute kidney
injury with various patho-mechanisms suggested [2]. One of these mechanisms is the alcohol
induced oxidative stress leading to production of excess free radicals that has the capability to
cause tissue injury and increase inflammation [2]. Nigeria is a developing country in West Africa
with pooled crude prevalence of harmful use of alcohol put at 34.3% (range of 28.6%-
40.1%)[3]. In Nigeria the rate of alcohol consumption varies among the various ethnic groups
and it was reportedly common among young adults [4]. The likelihood of children having more
exposure and access to alcohol is higher now that the young adults who drink alcohol are giving
birth to children. Teenagers, especially the early adolescent (10-13years) and mid-adolescent
age (14-16years) are vulnerable and are usually willing to try out new ways of life without
considering the possible ill effect or outcome. They are readily under peer pressure and strong
emotions often continue to drive their decisions when impulses come into play.
CASE REPORT
The patient was a 13-year-old Nigerian boy who was admitted because of 4 episodes of
vomiting of 24 hours duration, convulsion of 4 episodes within 3hrs prior to presentation with
associated loss of consciousness. He was apparently well until the outset of symptoms when he
started vomiting, it was non bloody, non-bilious, non-projectile, contained recently ingested
substances. The convulsion was generalised, tonic-clonic in nature, several epsiodes, each
episode lasting for about 5mins, with spontaneous abortion and there was associated loss of
consciousness. There was no fecal or urinary incontinence. History of reduction in urine could
not be ascertained
There was a history of alcohol consumption about 3hrs prior to onset of symptoms. He was said
to have ingested about 250mls of ‘LORDS’ dry gin, containing 43% alcohol which was mixed
with Cocacola at his uncle’s birthday party. There was previous history suggestive of illicit
substance abuse (name of substance could not be ascertained), peer pressure and inadequate
parental supervision. There was no associated fever, prior history of trauma to the head or
convulsions, and there was no family history of convulsion. There were no complaints of
headaches, chest pain or abdominal pain prior to onset of symptoms. There was no past medical
history of hospital admission.
He was taken to a private health facility where IV anticonvulsant was administered before
referral to our health institution.
Family and social history showed that he was the last of five children. The parents were
separated. He was sharing a room with a 25-year-old brother who was an alcoholic. The mother
was a 55-year-old petty trader.
On examination, he was unconscious Glasgow coma score= 3/15, not in respiratory distress,
not pale, afebrile- 37.0oC, anicteric, acyanosed, no evidence of dehydration, there was no pedal
oedema.
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British Journal of Healthcare and Medical Research (BJHMR) Vol 10, Issue 2, April- 2023
Services for Science and Education – United Kingdom
Respiratory system examination revealed a respiratory rate of 29 cycles per minute, the SPO2
in room air was 98% and breath sound was vesicular.
Cardiovascular system showed a pulse rate of 112 beats per minute, which was regular and of
full volume, blood pressure was 130/50 mmHg (systolic hypertension), the first and the second
heart sounds were heard and there was no murmur.
On gastrointestinal system examination, his abdomen was flat, moved with respiration, there
was no palpable organ enlargement.
Central nervous system examination showed that he was unconscious with Glasgow coma score
of 3/15 (had sedative administered prior to examination). Pupils were of equal size,3mm and
slowly reactive to light bilaterally. There was no sign of meningeal irritation, tones and reflexes
were normal in all limbs.
An assessment of Coma probably secondary to Alcohol induced Encephalopathy was made to
keep in view acute kidney injury.
He was admitted in the Children Emergency Ward, blood samples were collected for random
blood sugar, electrolyte and urea, full blood count, urine sample for urinalysis, urine toxicology
test, urethra catheter passed for strict monitoring of his urine output, he also had serology for
retroviral and hepatitis done while preparing him for dialysis.
RESULTS
The investigation results showed hyperglycaemia (RBS – 14mmol/L), negative retroviral and
Hepatitis B surface antigen screenings, urine toxicology was negative for cannabinoids, opiates,
amphetamine ad cocaine but positive for benzodiazepine (had diazepam injection prior sample
collection). His urine output was 0.67ml/kg/hr.
TABLE 1: Result of urinalysis
URINALYSIS PARAMETERS 10-09-2022 11-09-2022
Blood +++ ++
Urobilinogen - -
Bilirubin - -
Protein + +
Nitrite - -
Ketones - -
Ascorbic acid + -
Glucose + +
pH 5.0 5.0