Impact of electrolyte disturbances in outcome of acute diarrhoea in children

JA Begum1, MM Hoque2, M Hussain3, MNA Hasan4, MH Molla5
Background: Acute diarrhoeal diseases are among the leading causes of mortality
in infants and young children in many developing countries. Electrolyte abnormalities
are common in children with diarrhea that may remain unrecognized and result in
mortality and morbidity.
Objective: The study was carried out to determine how often electrolyte disturbances
occur in children with acute diarrhoea and whether these findings had impact on
mortality and hospital stay.
Methods: This study was carried out in Dhaka shishu hospital during the period of
December 2009 to May 2010. It was a cross sectional hospital based study and
included cases of diarrhea in the age group1 month to 5 years of both sexes. Patients
with acute diarrhea, admitted in inpatient department through emergency department
were enrolled in the study. A trained physician in the emergency department took
the history, examined the patient and assesed hydration status and classified as no,
some, severe dehydration based on a standard clinical scale. Attending physician
managed the patients according to unit protocol. Two ml of whole blood was collected
and sent for electrolyte at the time of insertion of I/V cannula before giving I/V
fluid. The physician followed the patient and recorded electrolyte report,outcome
and hospital stay. Data analysis was done using SPSS version 12. Student,s t test
was done to test significant difference in mortality and hospital stay in patients with
normal and abnormal electrolytes.
Results: The study group consisted of 100 children (51 boys and 49 girls). Majority
patients were within 1 year (79%) of age. Electrolyte was done in 86 patients. Abnormal
laboratory values were found in 34 patients out of 86 children. Twenty seven (31.4%)
had hypokalemia which was isolated in 20 (23.3%) and with hyponatremia 7(8.1%)
cases. Hyponatremia was found in 13(15.1%) cases, isolated in 6(6.9%) and with
hypokalemia 7(8.1%) cases.
Among these patients 2 patient died who have severe dehydration and sodium level
<120 meq/L and potassium <2.5meq/L. There was no significant difference in hospital
stay among the survivors with normal and abnormal electrolyte level but significant
difference in mortality in relation to serum sodium and potassium level.
Conclusion: Hypokalemia and hyponatremia are common electrolyte abnormalities
seen in children with acute diarrhea in this study. These are associated with increased
mortality when patients have worsening hyponatremia (sodium<120meq/L) and
hypokalemia ( potassium<2.5 meq/L).
Keywords: Electrolyte disturbances, Acute diarrhoea, Outcome

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