The electrolyte profile of severely malnourished children aged 6-59 months, presenting to the University Teaching Hospital, Lusaka

Abstract

Objective: To determine the electrolyte profile of severely malnourished children aged 6-59 months, presenting to UTH, Lusaka. Methods: This was a cross sectional study conducted at UTH, malnutrition ward, where patients with SAM with complications are admitted. On admission, patients presenting to the malnutrition ward were assessed by taking history and performing physical examination. The patients` anthropometric measurements like weight and height were done. Weight for height Z scores (WHZ) were determined using the WHO growth charts. Patients with Weight for Height Z scores < -3 SD or with nutritional bipedal pitting oedema and aged 6-59 months were enrolled in the study. Convenience sampling method was used and consent was obtained from the caregivers. Children in the study were managed and received feeds and fluids as per WHO protocol for SAM. Electrolytes were done on admission, on day 3 and on day 8, and children were either classified as hypo /hyper natremic or hypo/hyper kalemic depending on their electrolyte levels and comparisons were done using appropriate statistical analysis. Results: In this study, 245 participants were enrolled. 60.41% (148/245) were male and 39.59% ( 97/245) were female. 75.10% (184/245) of the participants were in the 12-35 months age group. 57.55% (141/245) had diarrhoea and 42.45% (104/245) had no diarrhoea. 69.80% (171/245) had severe wasting while 30.20% (74/245) had bilateral pitting pedal oedema. Of those tested for HIV, 79.06 % (185/234) were HIV negative and 20.94% (49/234) were HIV positive. Sodium On day 1 (n=243), 54.73% (133/243) had hyponatremia, 4.94% (12/243) had hypernatremia, and 40.33% (98/243) had normal sodium serum levels. Mean sodium was 133.23± 8.40 (range 100-154). v On day 3 (n=41), 60.98% (25/41) had hyponatremia, 5.00% (2/41) had hypernatremia and 34.15% (14/41) had normal serum sodium. Mean sodium was 131.75 ± 8.17 (range 110-158). On day 8 (n=18), 50% (9/18) had hyponatremia, 5.56% (1/18) had hypernatremia, and 44.44% (8/18) had normal serum sodium. Mean sodium was 135 ± 9.9 (range 126-173). Potassium Day 1 (n=235), 36.60% (86/235) had hypokalemia, 34.47% (81/235) had hyperkalemia,and 28.94% (68/235) had normal serum potassium levels. Mean potassium was 4.08 ± 1.57 (range 1.5-8.7). Day 3 (n=41), 85.37% (35/41) had hyperkalemia, 2.44% (1/41) had hypokalemia and 12.20% (5/41) had normal serum potassium. Mean potassium was 5.46 ± 1.02 (range 2.9-7.7). Day 8 (n=17), 5.88% (1/17) had hypokalemia, 72.22% (13/17) had hyperkalemia and 17.65% (3/17) had normal serum potassium. Mean potassium was 5.5 ± 1.34 (3.3-9.2) Statistical analysis showed that patients who presented with diarrhoea were more likely to have hypokalemia as a potassium derangement; 62.79% of patients with hypokalemia had diarrhoea as compared to 37.21% of patients without diarrhoea (P=0.015<0.05). In those with hyponatremia (n=133), 51.8% (72/133) had diarrhoea while, 58.7% (61/133) had no diarrhoea. 75% (9/12) of those with hypernatremia (n=12) had diarrhoea while 25% (3/12) had no diarrhoea. 59.18% (58/98) of those with normal sodium values had diarrhoea and 40.82% (40/98) had no diarrhoea. However, there was no significant hyponatremia or hypernatremia in those with diarrhoea, (P=0.329>0.05) There was no significant serum electrolyte changes among those with oedema and those with severe wasting, those with HIV and those with no HIV, those who died and those who were alive. vi Conclusion: Most of the children with SAM and electrolyte derangements also had diarrhoea. Therefore determination of the electrolyte profile of all patients with SAM immediately on admission and proceeding days after admission is vital as it helps the clinician to decide on the most appropriate fluids to give to help reduce on the morbidity and mortality associated with life threatening electrolyte derangements. Keywords: serum sodium, potassium, severe acute malnutrition, diarrhoea