Post Graduate in General Medicine

From

Dr. ABEER GOEL

Post Graduate in General Medicine

Department of Medicine.

Mysore Medical College and Research Institute

Mysore

To

Registrar (Evaluation)

Rajiv Gandhi University of Health Sciences

Bangalore.

Through Proper Channel

Respected Sir,

Subject: Submission of Synopsis titled “HYPOKALEMIA IN DENGUE FEVER- A DESCRIPTIVE STUDY”

I am hereby submitting the above titled synopsis, so kindly accept my application and do the needful.

Thanking you,

Yours faithfully,

(Dr. ABEER GOEL)

Forwarded to The Dean and Director, Mysore Medical College and Research Institute, Mysore for further needful action.

PROFESSOR AND HOD

Date: Department of General Medicine

Place: Mysore Mysore Medical College and

Research Institute, Mysore.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. / Name of the Candidate and Address / : / Dr. ABEER GOEL
Post Graduate IN GENERAL MEDICINE
department of MEDICINE
Mysore Medical college and Research Institute,
Mysore – 570 001.
2. / Name of the Institution / : / MYSORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, MYSORE
3. / Course of study and subject / : / M.D. (GENERAL MEDICINE)
4. / Date of Admission to the Course / : / 30-05-2013
5. / Title of the Topic / : / HYPOKALEMIA IN DENGUE FEVER- A DESCRIPTIVE STUDY
6. / BRIEF RESUME OF THE INTENDED STUDY
6.1 Need for the study
•  Dengue fever is an arthropod borne viral fever acquiring epidemic proportion in tropical and sub tropical climate including Karnataka. It has become a major public health problem with high morbidity and mortality. Clinical presentation varies from a severe flu like illness to a potentially lethal haemorrhagic fever and dengue shock syndrome.
•  It is vital to recognise at the earliest the signs, symptoms and alterations in biochemical parameters in dengue patients to reduce mortality. Among these hypokalemia is one of the possible manifestations of dengue fever, not widely recognised.
•  Hypokalemia is defined as a plasma K+ concentration below 3.5 mmol/L.1 Patients with hypokalemia often have no symptoms, particularly when the disorder is mild (3.5-3 mEq/L). With more severe hypokalemia, nonspecific symptoms, such as generalized weakness, lassitude, and constipation, are more common. In severe hypokalemia, muscle necrosis can occur, and at serum concentrations of less than 2.0 mmol per litre, an ascending paralysis can develop, with eventual impairment of respiratory function.2
•  The clinical profile of dengue is changing, and the neurological manifestations are reported more frequently. Neurological manifestations include encephalitis, aseptic meningitis, neuropathies, Guillain-Barre syndrome, myelitis, intracranial haemorrhage and thrombosis. Some of these manifestations are associated with hypokalemia. Prevalence study of hypokalemia in dengue is rarely reported. Awareness of this and screening for potassium levels will help the physician to keep the possibility of
hypokalemia in dengue patients and manage its possible complications of paresis and eventual impairment of respiratory function.
•  Also this study will underline the importance of using potassium rich fluids as replacement fluid in management of dengue fever.
6.2 Review of literature
•  In a cross sectional study carried out in Internal Medicine wards, Cipto Mangunkusumo General hospital in Jakarta, Widoto et al observed prevalence of hypokalemia in infectious diseases particularly dengue cases in up to 23% of serologically proven cases of dengue infection.3
•  In a retrospective study done on clinical data from 1342 patients with dengue fever seen from 2002 to 2006 in Guangzou, Ying R.S. et al observed prevalence of hypokalemia in up to 28% of cases.4
•  Jha and Ansari reported three confirmed cases of dengue infection causing acute reversible hypokalemic pure motor quadriparesis.5
•  Guptaet al reported that dengue fever can precipitate the attack of hypokalaemic periodic paralysis; however, dengue fever causing pure motor quadriparesis due to hypokalaemia was only occasionally reported.
•  Kalita et al studied 16 patients with dengue quadriparesis, in seven it ws due to myositis.
6.3 Aims and Objectives of the study
•  To study the prevalence of hypokalemia in dengue fever.
•  To study the neurological manifestation of dengue fever.
•  To study the presence of hypokalemia in neurological manifestations of dengue.
7. MATERIALS AND METHODS
7.1 Source of data
Primary observed data of Dengue cases admitted as inpatient to KR hospital, Mysore during the period of December 2013 to December 2014.
7.2 Method of collection of data (Including sampling procedure if any)
The data is collected from subjects fulfilling inclusion and exclusion criteria and admitted as inpatients in KR hospital, Mysore.
Sample size :350
Sampling method: Descriptive study
7.3 Inclusion criteria:
Subjects with clinical features suggestive of dengue infection, later on confirmed by dengue serology will be included in study.
7.4 Exclusion criteria:
1.  Subjects withg mixed infections.
2.  Subjects taking any medication causing hypokalemia.
3.  Subjects with renal insufficiency.
7.5 Method Of Study
All those who are going to get admitted as inpatients in KR Hospital, Mysore with symptoms suggestive of Dengue fever i.e. fever, severe headache, joint pains, retro orbital pain, bleeding manifestation and shock are investigated with dengue serology. Those found positive for either of the tests are included in study and informed consent is taken from all patients.
A detailed clinical history is taken from all patients followed by thorough clinical examination of all systems. They are further investigated with all biochemical, microbiological, haematological and radiological investigations mentioned in study protocol.
Serum potassium levels are checked at the time of admission and further every alternate day till the time of discharge.
•  Investigations
1.  Complete haemogram
2.  Dengue serology for IgG, IgM, NS-1 Antigen
3.  Serum electrolytes, blood urea, serum creatinine
4.  Random blood sugar
5.  Urine routine
6.  Malarial parasite(QBC) and Widal test
7.  Liver function test
8.  ECG, ultrasound abdomen, chest x-ray
•  Following investigation will be done whenever necessary
1.  Blood culture, urine culture
2.  HbsAg, anti HCV, Leptospira IgM antibody
Statistical Methods
·  Descriptive statistics(mean standard deviation, proportion)
·  Chi square test/ z test of proportion, multiple Bar and Pie chart.
·  Contingency coefficient.
Related statistical techniques using SPSS version 17.0 (for windows 7.1)
7.6 Does The Study Require Any Investigation / Intervention To Be Conducted On Patients Or Other Humans Or Animals?
Yes
7.7 Has Ethical Clearance Been Obtained From Your Institution In Case Of 7.6?
Yes (copy enclosed)
8. REFERENCES
1.  Singer GG, Brenner BM. Fluid and electrolyte disturbances. In: Braunwald E, Fauci AS, Kasper DL, et al, eds. Harrison’s principles of internal medicine. 18th ed. New York: Mc Graw Hill; 2001. p. 279-83.
2.  Walters EG, Barnes IC. A survey of hypokalemia in patients of general practitioners. Br J Clin Pract. 1988;42(5):192-5.
3. Widodo D, Setiawan B, Chen K, et al.The prevalence of hypokalemia in hospitalized patients with infectious diseases problem at Cipto
Mangunkusumo Hospital, Jakarta.Acta Med Indones.2006;38:202–5
4. Ying RS, Tang XP, Zhang FC, et al.Clinical characteristics of the patients with dengue fever seen from 2002 to 2006 in Guangzhou.Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi.2007;21:123–5.
4.  Jha S, Ansari MK.Dengue infection causing acute hypokalemic quadriparesis.Neurol India.2010;58:592–4.
9. SIGNATURE OF THE CANDIDATE
10.REMARKS OF THE GUIDE
11.1 NAME AND DESIGNATION OF THE GUIDE / dr .mM. Basavaraju
assistant professor
department of medicine
MMC& RI
11.2 SIGNATURE OF THE GUIDE
11.3 HEAD OF THE DEPARTMENT / DR.MOHAMMED GHOUSE SHARIFF
PROFESSOR
DEPARTMENT OF MEDICINE
MMC& RI
11.4 SIGNATURE OF THE H.O.D
12.1 REMARKS OF THE DIRECTOR AND DEAN
12.2 SIGNATURE

ETHICAL COMMITTEE CLEARANCE

1. / TITLE OF DISSERTATION / : / “HYPOKALEMIA IN DENGUE FEVER- A DESCRIPTIVE STUDY”
2. / NAME OF THE CANDIDATE / : / Dr. ABEER GOEL
3. / SUBJECT / : / M.D. (GENERAL MEDICINE)
4. / NAME OF THE GUIDE / : / Dr. MM. BASAVARAJU
Assistant Professor
Department Of General Medicine
Mysore Medical College and
Research Institute, Mysore.
5. / Approved / Not Approved
(If not approved, suggestion) / :

SUPERINTENDENT SUPERINTENDENT

K.R. Hospital Cheluvamba Hospital

Mysore Mysore

PROFESSOR AND HOD PROFESSOR AND HOD

Department of Medicine Department of surgery

MMC & RI MMC& RI

Mysore Mysore

SUPERINTENDENT LAW EXPERT

PKTB sanitarium

Mysore.

DEAN AND DIRECTOR

Mysore Medical College and Research Institute, Mysore

SCIENTIFIC COMMITTEE CLEARANCE

TITLE OF THE DISSERTATION: “HYPOKALEMIA IN DENGUE FEVER- A

DESCRIPTIVE STUDY”

NAME OF THE CANDIDATE: Dr. ABEER GOEL

SUBJECT: M.D. GENERAL MEDICINE

NAME OF THE GUIDE: Dr. MM. BASAVARAJU, M.D.

ASSISTANT PROFESSOR

DEPARTMENT OF GENERAL MEDICINE

MYSORE MEDICAL COLLEGE & RESEARCH INSTITUTE, MYSORE

Reviewed and approved by the scientific committee for submission to RGUHS

DATE: Dr. M.A. SHEKAR

PLACE: MYSORE CHAIRMAN,

SCIENTIFIC COMMITTEE

MMC & RI, MYOSRE

6