Electrolyte abnormalities among critically ill children presenting to acute care unit, Mulago hospital: Types, associated factors, and immediate outcome

Abstract

BACKGROUND:Electrolyte abnormalities are commonly seen in critically ill children and have been associated with poor outcome. However electrolyte abnormalities among critically ill children in resource poor settings are poorly described. The types, associated factors and immediate outcome of electrolyte abnormalities among critically ill children presenting to the Acute Care Unit- Mulago hospital are herein described. METHODS: This was a prospective observational study carried out in the paediatric wards of mulago hospital. Children aged 2-59 months who presented to hospital with emergency signs were recruited from the ACU and followed up for the first 48 hours of their hospitalization. The levels of various serum electrolytes were measured at presentation and related to data on socio-demographic as well as the presenting clinical features recorded. The survival staus at 48 hours was used to determine the immediate outcome of hospitalization. Data was entered with epidata 3.1 and analysed with SPSS. Results: Two hundred and seventy eight (278) children presented to ACU with emergency signs during the study period of which 258 (97.5%) were included in this analysis. Atleast one electrolyte abnormality was presented in 224/258 (86.8%) of the participants. Acidosis was the commonest abnormality seen in 170/258 (65.9%), followed by hyperkalemia in 37/258 (14.3%) of the study participants. The other electrolyte abnormalities included hypokalemia in 35/258 (13.6%), hypercalcemia in 32/258 (12.4%) and hypermagnesemia in 30/258 (11.6%). Hypomagnesemia, hyponatremia, hypernatremia and hypocalcemia were rarely seen occurring in 2/258 (0.8%), 9/258 (3.5%), 12/258 (4.7%) and 21/258 (8.1%) of the study participants respectively. Acidosis was associated with impaired consciousness (OR=2.39, 95%CI:1.29, 4.41 P=0.006). Hypokalemia was found to be independently associated with diarrhoea with severe dehydration (OR=3.90, 95%CI:1.77, 8.60 P=0.001, impaired consciousness (OR=4.71, 95%CI 2.16, 10.33 P= 0.000) and severe anaemia (OR= 0.45, 95%CI:0.24, 0.87, P=0.017). The overall mortality rate for the study participants was 28/258 (10.9%) whereas 27/224 (12%) of children with electrolyte abnormalities died. Children with electrolyte abnormalities were more likely to die compared to other critically ill children (p=0.020), with acidosis independently associated with increased risk of mortality (OR 5.46, 95%CI: 1CONCLUSION: Electrolyte abnormalities are common among critically ill children with acidosis being the commonest form. The presence of electrolyte abnormalities amongst critically ill children is associated with poor outcome. Recommendations: Clinicians looking after critically ill children should investigate for electrolyte abnormalities and provide appropriate treatment for these. Metabolic acidosis should be indentified early with use of simple clinical signs and appropriate treatment started among critically ill children. Further studies are needed to describe the recognition of, and factors associated with specific electrolyte abnormalities and whether early correction of these abnormalities will reduce mortality in our settings.