Clinical Manifestations Of Hypokalemia

Abstract

OBJECTIVE: To observe the clinical manifestations of hypokalemia resulting from acute watery diarrhoea. DESIGN: A descriptive study. SETTING: Paediatrics department, Isra University Hospital Hyderabad, Sindh from April 2004 to April 2005. PATIENTS AND METHODS: Children less than 5 years of age with acute watery diarrhoea and vomiting who were found to have hypokalemia were included in this study. Children with chronic diarrhoea (more than 14 days duration) or hypokalemia of any other cause such as Bartter’s syndrome etc. were excluded. Children with paralytic ileus due to other causes such as anti-diarrhoeal drugs etc. were also excluded. Serum potassium levels were checked at Isra University research laboratory by the standard ion selective electrode method. Hypokalemia was defined as serum potassium level of less than 3.5 mEq/l. The clinical presentations of children with hypokalemia were recorded and statistically analysed. RESULTS: During study period, 350 children with acute watery diarrhoea were admitted. Of these, 130 (37.14 %) were hypokalemic and were included in this study, whereas 220 (62.85 %) children were normokalemic (normal serum potassium level) and therefore were excluded from study. Abdominal distention was the commonest manifestation in 110(84.61%) children followed by head flop in 90(69.23%) cases, diminished bowel sounds in 55(42.30%), paralytic ileus in 30 (23.07%), inability to sit, stand or walk in 45(34.61%) and aphonia or dysphonia in 15(11.53%) children. Five children (3.84%) with hypokalemia had no clinical manifestation. Examination revealed weakness of limbs in 35 children, out of which 30 children had quadriparesis and 5 had paraparesis. CONCLUSION: Hypokalemia is an important electrolyte disturbance with acute diarrhoea. It may have serious clinical manifestations like abdominal distention, paralytic ileus, and can even lead to cardiac arrhythmias and arrest. Although, it can have fatal morbidities, timely intervention yields encouraging results.