Prevalence of Electrolyte Abnormality and its Correlation with Clinical Features and Patient Outcomes in Children Admitted to Pediatric Intensive Care Unit of a Resource-Constrained Setting in India.

BACKGROUND

Pediatric patients with critical illnesses often exhibit serum electrolyte disturbances, which significantly influence their clinical outcomes.

METHODS

This prospective observational study included 534 pediatric patients (age range 1 month to 18 years) admitted to the pediatric intensive care unit of R.D. Gardi Medical College, Ujjain, from January 1, 2023 to April 30, 2024. The objective of the study was to study associations of disturbances in the levels of serum sodium, potassium, calcium, magnesium, and phosphorus with organ system involvement and child mortality, using multiple logistic regression models.

RESULTS

Among the 534 patients, 325 (61%) were boys and 209 (39%) were girls, with a mean ± SD age of 5.17 ± 4.79 years. Most patients presented with fever (71%), fatigue (34%), and malaise (21%). A total of 1057 electrolyte abnormalities were recorded, with hypocalcemia (263 episodes, 25%) being the most common, followed by hypokalemia (192 episodes, 18%) and hyponatremia (172 episodes, 16%). A total of 173 episodes of severe hypocalcemia (S. calcium <6.5 mg/d), 21 episodes of severe hypernatremia (S. sodium >150 mEq/L) and 12 episodes of hypokalemia (S. potassium <2.5 mEq/L). All children with hypocalcemia had neurological symptoms. Hypokalemia was significantly associated with neurological (adjusted odds ratio 2.07), endocrine (adjusted odds ratio 2.26) and cardiovascular system (adjusted odds ratio 10.20) symptoms. Hyponatremia was significantly associated with symptoms of respiratory system (adjusted odds ratio 2.82) and gastrointestinal system (adjusted odds ratio 1.95). Hyperkalemia was significantly associated with symptoms of neurological (adjusted odds ratio 3.84), endocrine (adjusted odds ratio 2.24) and cardiovascular system (adjusted odds ratio 3.53). A total of 34 (6%) deaths were recorded and found to be associated mainly with hypokalemia (56%), hypocalcemia (44%), and hyponatremia (32%). Among these, hypokalemia (odds ratio: 2.43) and hypernatremia (odds ratio: 2.26) were significantly associated with mortality.

CONCLUSION

Electrolyte abnormalities were highly prevalent among children in the pediatric intensive care unit, with imbalances in the calcium, potassium, and sodium levels being the most common. Hypokalemia and hypernatremia were significantly and positively associated with mortality.