Electrolyte imbalances and their impact on outcomes in critically ill children: a prospective study from North India
DOI:
https://doi.org/10.18203/2349-3291.ijcp20253481Keywords:
Dyselectrolytemia, Electrolyte imbalance, Hyponatremia, Hyperkalemia, Hypocalcemia, Mortality, MODS, Pediatric intensive careAbstract
Background: Electrolyte imbalances are frequent in critically ill children and significantly influence prognosis, yet pediatric data from North India remain scarce. To determine the prevalence of electrolyte imbalances in a tertiary care pediatric intensive care unit (PICU) and assess their associations with morbidity, mortality and clinical outcomes.
Methods: This prospective observational study included 196 children (1 month–18 years) admitted to a North Indian tertiary PICU over 18 months. Electrolyte levels were measured at admission and monitored daily. Associations between dyselectrolytemia and outcomes including ventilatory and inotropic needs, complications, length of stay and mortality were analyzed using chi-square tests.
Results: Electrolyte imbalance was observed in 58.2% of patients, with hyponatremia (52.6%) being most common, followed by hypocalcemia (13.8%) and hyperkalemia (7.1%). Dyselectrolytemia was significantly associated with prolonged PICU stay (p<0.0001), need for ventilation and inotropes (p<0.0001), complications (42.9%), MODS (11.2%) and higher mortality (p<0.0001). Seizures were the most frequent complication (20.4%). Mortality was highest with hyperkalemia (78.6%), followed by hypernatremia (57.1%) and hypokalemia (57.1%), whereas hyponatremia showed a non-significant trend. Overall mortality was 9.2%, lower than prior reports, possibly due to early monitoring and timely correction.
Conclusions: Electrolyte disturbances are common in PICU and strongly associated with adverse outcomes. Hyperkalemia and hypernatremia carry the greatest mortality risk. Early recognition and prompt correction of dyselectrolytemia may reduce morbidity and improve survival. Larger multicentre studies incorporating additional electrolytes such as magnesium and phosphate are warranted.
Metrics
References
Pollack MM, Holubkov R, Funai T, Clark A, Berger JT, Meert K, et al. Pediatric intensive care outcomes: development of new morbidities during pediatric critical care. Ped Crit Care Med. 2014;15(9):821-7. DOI: https://doi.org/10.1097/PCC.0000000000000250
Kiran VA, Chaudhary R. Clinical profile and outcome of children with serum electrolyte abnormalities in pediatric intensive care unit. Ann Romanian Soc Cell Biol. 2021;25(1):3914-20.
Naseem F, Saleem A, Mahar IA, Arif F. Electrolyte imbalance in critically ill paediatric patients. Pak J Med Sci. 2019;35(4):1093. DOI: https://doi.org/10.12669/pjms.35.4.286
Agarwal N, Rao YK, Saxena R, Acharya R. Profile of serum electrolytes in critically ill children: A prospective study. Indian J Child Health. 2018;24;5(2):128-32. DOI: https://doi.org/10.32677/IJCH.2018.v05.i02.014
Sehgal S, Gupta S, Mishra MK. Electrolytes and acid-base disorders. InClinical Applications of Biomolecules in Disease Diagnosis: A Comprehensive Guide to Biochemistry and Metabolism. 2024: 155-175. DOI: https://doi.org/10.1007/978-981-97-4723-8_7
Sharma K, Rathoria E, Srivastava M, Singh SK, Bansal U, Singh S, et al. Clinico-etiological profile of seizures in the pediatric age group. Int J Contemp Pediat. 2024;11(12):1752. DOI: https://doi.org/10.18203/2349-3291.ijcp20243472
Chagantipati VS, Bansal U, Rathoria E, Singh V, Gupta NB, Ahuja R. The spectrum of first-onset seizures in children presenting at a tertiary care centre. Adv Human Biol. 2024;14(2):132-7. DOI: https://doi.org/10.4103/aihb.aihb_110_23
Khairunnisa AR, Peryoga SU, Widiasta A. Acid-Base and Electrolytes Profile in Critically Ill Pediatric Patients Admitted to Pediatric Intensive Care Unit (PICU). Majalah Kedokteran Bandung. 2025;57(1):43-52. DOI: https://doi.org/10.15395/mkb.v57.3854
Hassan M, Khan M, Mukti A, Roy S, Begum M, Ferdous Z, et al. Electrolyte imbalance in hospitalized children with infections-a tertiary care Experience. Northern Int Med Coll J. 2022:588-93. DOI: https://doi.org/10.3329/nimcj.v13i1.73545
Sahu UP, Farooquee MR, Hasan O, Ehtesham S, Hasan R, FAROOQUEE MR, et al. A Cross-Sectional Study on the Observation of Clinical Profiles and Associated Electrolyte Disturbances in Patients Admitted to the Pediatric Intensive Care Unit (PICU) at a Tertiary Care Center. Cureus. 2025;20:17. DOI: https://doi.org/10.7759/cureus.77698
Vithalani H, Bamnawat S, Chapani P, Rani KA, Bamnawat S. Clinical profile and outcome of children with dyselectrolytemia admitted in pediatric intensive care unit. Int J Med Sci Current Res. 2025;8(1):432.
Suryawanshi P, Dhaneria M, Chaturvedi A, Yadav A. Correlation of Electrolyte Abnormalities with Severity of Illness in Critically Ill Patients of NICU and PICU AT CRGH and Associated Hospital of RD Gardi Medical College Ujjain (MP). Int J Health Sci. 2012;6(8):2602-10. DOI: https://doi.org/10.53730/ijhs.v6nS8.12674
Kumari S, Himanshu A, Rani P, Kumar R. A prospective study of analysis of electrolytes in pediatric patients admitted in ICU. Int J Health Sci. 2022;6(7):2370-6. DOI: https://doi.org/10.53730/ijhs.v6nS7.11863
Al-Sofyani KA. Prevalence and clinical significance of hyponatremia in pediatric intensive care. J Pediat Inten Care. 2019;8(03):130-7. DOI: https://doi.org/10.1055/s-0038-1676635
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. DOI: https://doi.org/10.1177/0885066613491708
Sadeghi-Bojd S, Noori NM, Damani E, Teimouri A. Electrolyte disturbances in PICU: a cross sectional study. Nephro-Urol Mon. 2019;11(2):87925. DOI: https://doi.org/10.5812/numonthly.87925
Panda I, Save S. Study of association of mortality with electrolyte abnormalities in children admitted in pediatric intensive care unit. Int J Contemp Pediatr. 2018;5(3):1097-103. DOI: https://doi.org/10.18203/2349-3291.ijcp20181550
Berhanu Y, Yusuf T, Mohammed A, Meseret F, Demeke Habteyohans B, Alemu A, et al. Hyponatremia and its associated factors in children admitted to the pediatric intensive care unit in eastern Ethiopia: a cross-sectional study. BMC Pediatr. 2023;23(1):310. DOI: https://doi.org/10.1186/s12887-023-04118-7
Jadhav R, Dhivakar K T, Avileli H, Pande V, Agarkhedkar S, Agarkhedkar S. Dyselectrolytemia and its outcome in critically ill children- A Prospective study. Eur J Mol Clin Med. 2023;10(1):3208-13
Elala G, Shimelis D. Patterns of electrolyte abnormalities in children 0-15 years of age admitted to pediatric emergency and intensive care units of a tertiary hospital. J Dental Med Sci. 2018;17(2):12-6.
Singh A, Rathoria E, Singh SK, Rathoria R, Yadav SK, Bansal U. Prevalence of overweight and obesity and associations with socio-demographic and etiological factors. Int J Contemp Pediatr. 2024;11(10):1400-5. DOI: https://doi.org/10.18203/2349-3291.ijcp20242735
Song HJ, Chia AZ, Tan BK, Teo CB, Lim V, Chua HR, et al. Electrolyte imbalances as poor prognostic markers in COVID-19: a systemic review and meta-analysis. J Endocrinol Investig. 2023;46(2):235-59. DOI: https://doi.org/10.1007/s40618-022-01877-5
Larivée NL, Michaud JB, More KM, Wilson JA, Tennankore KK. Hyperkalemia: prevalence, predictors and emerging treatments. Cardiol Therap. 2023;12(1):35-63. DOI: https://doi.org/10.1007/s40119-022-00289-z
Kobylecki CJ, Nordestgaard BG, Afzal S. Low plasma ionized calcium is associated with increased mortality: a population-based study of 106 768 individuals. J Clin Endocrinol Metabol. 2022;107(7):3039-47. DOI: https://doi.org/10.1210/clinem/dgac146
Weiss SL, Carcillo JA, Leclerc F, Leteurtre S, Schlapbach LJ, Tissieres P, et al. Refining the pediatric multiple organ dysfunction syndrome. Pediatrics. 2022;149(1):13-22. DOI: https://doi.org/10.1542/peds.2021-052888C
Sethi SK, Bunchman T, Chakraborty R, Raina R. Pediatric acute kidney injury: new advances in the last decade. Kidney Res Clin Pract. 2021;40(1):40. DOI: https://doi.org/10.23876/j.krcp.20.074
Antalová N, Klučka J, Říhová M, Poláčková S, Pokorná A, Štourač P. Ventilator-associated pneumonia prevention in pediatric patients: narrative review. Children. 2022;9(10):1540. DOI: https://doi.org/10.3390/children9101540
Kumar DP, Anupama A. Impact of COVID-19 pandemic era 2020 on Rashtriya Bal Swasthya Karyakram (RBSK)-National Child Health program in India–A cross-sectional comparative research study. 2022. DOI: https://doi.org/10.21203/rs.3.rs-1800841/v1
Khilnani P, Ramachandran B, Shaikh F, Sharma R, Sachdev A, Deopujari S, et al. Indian Academy of Pediatrics College Council of Pediatric Intensive Care Chapter. Consensus guidelines for pediatric intensive care units in India. Indian Pediat. 2020;57(11):1049-54. DOI: https://doi.org/10.1007/s13312-020-2034-0
Downloads
Published
How to Cite
Issue
Section
