DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20181550

Study of association of mortality with electrolyte abnormalities in children admitted in pediatric intensive care unit

Isha Panda, Sushma Save

Abstract


Background: Electrolyte abnormalities are common in critically ill children. In view of importance of electrolyte homeostasis and its significant impact on the final outcome of patient, the present study was undertaken. Objective of this study was to determine the prevalence of electrolyte abnormalities in children admitted in Pediatric Intensive Care Unit at the time of admission and its association with mortality and primary organ system involvement.

Methods: The study enrolled all the patients from 29 days to 12 years admitted in PICU of a tertiary care hospital during April 2015 to September 2016 (total 18 months). The children were classified according to presence or absence of electrolyte abnormality. The children were further divided into subgroups based on electrolyte values and mortality and organ system involvement was analyzed in each of the sub groups.

Results: The prevalence of electrolyte abnormality in terms of sodium or potassium abnormality in the present study was 44.31% (323 of 729). Hyponatremia (27.43%) was the most common electrolyte abnormality followed by hypokalemia (13.99%). The mortality in children with electrolyte abnormality was found to be 28.8% which was significantly higher than mortality in those without electrolyte abnormality. Maximum children with hyponatremia had central nervous system involvement (48.5%) and those with hypernatremia had gastrointestinal involvement (65.4%). Hypokalemia was most frequently observed with gastrointestinal involvement (54.9%) and hyperkalemia with renal involvement (34.8%).

Conclusions: Present study has demonstrated significant association of electrolyte abnormalities at admission in PICU with mortality and primary organ system involvement. Close monitoring and correction of electrolyte abnormalities is essential to reduce morbidity and mortality.


Keywords


Critically ill, Hyponatremia, Intensive care unit, Mortality, Water electrolyte imbalance

Full Text:

PDF

References


Rao SSD, Thomas B. Electrolyte abnormalities in children admitted to pediatric intensive care unit. Indian Pediatr. 2000;37:1348-53.

Singhi S, Prasad SVSS, Chugh KS. Hyponatremia in sick Children: a marker of Serious illness. Indian Pediatr. 1994;31:19-23.

Barron R, Freebairn R. Electrolyte disorders in the critically ill. Anaesth Intensive Care Med. 2010;11(12):523-8.

Hauser GJ, Kulick AF. Electrolyte disorders in the PICU. In: Wheeler DS et al, eds. Pediatric critical care medicine. London: Springer-Verlag; 2014;13:147-61.

Patel S. Sodium balance-an integrated physiological model and novel approach. Saudi J Kidney Dis Transpl. 2009;20:560-9.

Greenbaum LA. Pathophysiology of body fluids and fluid therapy. In: Kliegman RM, Stanton BF, St Geme III JW, Schor NF, editors. Nelson’s Textbook of Pediatrics. 20th ed. Canada: Elsevier; 2016:350-363.

Gibbs R, Macnaughton P. Electrolyte and metabolic disturbances in critically ill patients. Anaesth Intens Care Med. 2007;8(12):529-33.

Çaglar MK, Altugan FS, Ozer I. Exclusively Breastfeeding and Hypernatremic Dehydration. Iranian J Publ Health. 2005;34(3):1-11.

Hoskote SS, Joshi SR, Ghosh AK. Disorders of potassium homeostasis: pathophysiology and management. JAPI. 2008;56:685-93.

Singhi S, Marudkar A. Hypokalemia in a pediatric intensive care unit. Indian Pediatr. 1996;33:9.

Lehnhardt A, Kemper MJ. Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol. 2011;26:377-84.

Jain M, Shah A, Prajapati R. Study of electrolyte imbalance in critically ill children. Int J Int Med Res. 2015;2(2):56-9.

Ebrahim SAE, El gawad ERA, Ahmed BMEG. Electrolyte disturbances in critically ill patients. Int J Adv Res. 2016;4(3):88-93.

Ibinda F, Zarnack H-C, Newton CR. Sodium disturbances in children admitted to a kenyan hospital: magnitude, outcome and associated factors. 2016;11(9):e0161320.

Singhi S, Jayashre M. Free water excess is not the main cause for hyponatremia in critically ill children receiving conventional maintenance fluids. Indian Pediatr; 2009;46(7):577-83.

Funk GC, Lindner G, Druml W. Incidence and prognosis of dysnatremias present on ICU admission. Intensive Care Med. 2010;36(2):304-11.

Lindner, Funk GC, Schwarz C, Kneidinger N, Kaider A, Schneeweiss B, et al. Hypernatremia in the critically ill is an independent risk factor for mortality. Am J Kidney Dis; 2007;50(6):952-7.

Darmon M, Timsit JF, Francais A. Association between hypernatraemia acquired in the ICU and mortality: a cohort study. Nephrol Dial Transplant. 2010;25(8):2510-5.

Alharfi IM, Stewart TC, Kelly SH, Morrison GC, Fraser DD. Hypernatremia is associated with increased risk of mortality in pediatric severe traumatic brain injury. J Neurotrauma. 2013;30(5):361-6.

Singhi S, Gulati S, Prasad SVSS. Frequency and significance of potassium disturbances in sick children. Indian Pediatr. 1994;31:460-2.

Cummings BM, Macklin EA, Yager PH, Sharma A, Noviski N. Potassium abnormalities in a pediatric intensive care unit: frequency and severity. J Intensive Care Med. 2014;29(5):269-74.