Diagnostic challenges in critical care management of fluid and electrolyte disturbances in a poor-resource setting: a survey of critical care doctors

Lucius C. Imoh; Onyedika G. Okoye; Audu C. Abimiku; Alex O. Abu; Solomon A. Asorose; Promise O. Echebiri

doi:10.18203/2320-6012.ijrms20175427

Authors

Lucius C. Imoh Department of Chemical Pathology, Jos University Teaching Hospital, Jos, Nigeria
Onyedika G. Okoye Department of Surgery, National Hospital, Abuja, Nigeria
Audu C. Abimiku Department of Family Medicine, Federal Medical Centre, Keffi, Nasarawa State, Nigeria
Alex O. Abu Department of Chemical Pathology, Federal Medical Centre, Markudi, Benue State, Nigeria
Solomon A. Asorose Department of Chemical Pathology, Jos University Teaching Hospital, Jos, Nigeria
Promise O. Echebiri Department of Surgery, National Hospital, Abuja, Nigeria

DOI:

https://doi.org/10.18203/2320-6012.ijrms20175427

Keywords:

Critical care, Emergency department, Fluid and electrolytes, Intensive care, Low-middle-income countries, Point of care test

Abstract

Background: To determine the challenges in diagnostic support for adequate fluid and electrolyte (F/E) management in a poor-resource critical care setting.

Methods: This cross-sectional survey was conducted between March and May 2017 in one hundred and four (104) doctors practicing in four tertiary hospitals in North-central Nigeria. These doctors were currently working in Accidents and Emergency Units (A/E), Intensive care Units (ICU) and Children Emergency Units and have worked for at least two months prior to the study. They were given a structured questionnaire to fill and return. The questionnaire among other things, addressed laboratory-related factors that affect management of F/E disturbances.

Results: Unavailability of some laboratory tests, inaccuracy of laboratory results, incomplete test results and delay in obtaining results, hampered F/E management in critical care according to more than 75% of the surveyed doctors. About sixty percent of the doctors reported a turnaround time (TAT) of ≥3 hours for electrolytes and most emergency biochemical tests (except urine dipstick and Blood gases). Also ≤25% of doctors responded that electrolytes and most emergency biochemical tests (except urine dipstick and Blood gases) were offered in the ICU/Emergency unit laboratories. Ten percent or less of doctors reported that electrolytes and the emergency biochemical test were available by Point of care testing (POCT).

Conclusions: There is an urgent need for the managers of healthcare in LMICs to establish functional laboratories in ICUs, explore the use of POCT and build capacity for diagnostic critical care.

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