Chemistry 101

Remember in high school when we learned the periodic table and covered those low level elements sodium, potassium and chloride? Simple stuff really and those of us who went on to the biosciences came to appreciate the role these elements play in maintaining us as organisms. For about a hundred years medical practitioners have understood that their delicate balance is crucial in determining how our cells behave. We know that our kidneys can do a reasonably good job in making sure we retain enough sodium and chloride. They do not do so well with potassium and when there is a significant loss it needs to be replaced. This knowledge has not yet reached Sumbawanga or, I’m told, any hospitals outside the capital. So begins a sad story.

I saw a young man named Giles yesterday who had been ill for about a week. He had gone through the usual routine of traditional healers and incompetent medical officers and finally came to my attention. I got him on the operating table as soon as possible and found the expected typhoid-caused intestinal perforation which we closed and drained in the prescribed fashion. This type of operation which would be a rare and ominous event in our world is a three or four times a week here so as to be just about routine. The crucial issue is how long they have been sick and how much intestinal fluid, which is potassium rich, has been lost. In this case the loss was substantial, about two liters which we drained from his abdomen. The operation was uneventful, except that we had to close the abdomen by cell phone light because the electricity went out. That was an inconvenience but did not contribute to the result. The outcome was that the boy had a cardiac arrest and died as he was coming out of anesthesia. He arrested because his potassium level was so low that the transmission of electrical impulses in the heart was disturbed. That’s what happens when there is no way to replace the loss. This situation doubtlessly played a role in the other two deaths I have reported in very ill peritonitis patients. The tragedy here is that the concept has not been grasped by the medical community here. For four years I have been pleading with them to acquire some potassium compounds for replacement. They are not expensive but the powers that be simply cannot grasp the need to have them on hand. They also refuse to acknowledge the need to expand the availability of IV solutions beyond the very basics. “After all”, they say, “fluid is fluid, right?” Tell that to Giles’s family. He was fourteen years old.