Abstract
BackgroundClinical signs of pneumonia are often veiled in under-five diarrheal children presenting with hypokalemia, making clinical diagnosis of pneumonia very difficult in such population. However, there is no published report that describes the influences of hypokalemia on the clinical signs of pneumonia in diarrheal children. Our objective was to assess the influences of hypokalemia, and their outcome in such children.MethodsWe prospectively enrolled all under-five diarrheal children (n = 180) admitted to the Special Care Ward of the Dhaka Hospital of icddr,b from September-December 2007 with radiological pneumonia who also had their serum potassium estimated. We compared the clinical features and outcome of the diarrheal children having pneumonia with (cases = 55) and without hypokalemia (controls = 125).ResultsThe case-fatality among the cases was 2 times higher compared to the controls, but the difference was not statistically significant (p = 0.202). In logistic regression analysis, after adjusting for potential confounders such as age of the patient, clinical dehydration, severe wasting, abnormally sleepy, lower chest wall in-drawing, nasal flaring and inability to drink on admission, under-five diarrheal children with pneumonia who presented with nutritional edema had 3 times more risk to have hypokalemia compared to those without nutritional edema (OR = 2.76, 95% CI = 1.01–7.51) and these hypokalemic children were 64% less likely to present with fast breathing (OR = 0.36, 95% CI = 0.17–0.74).Conclusion and significanceThe results of our analysis are simple but may have great public health implications and underscore the importance of diligent assessment for pneumonia in under-five diarrheal children having risk of hypokalemia as in children with nutritional edema even in absence of fast breathing, a useful sign of pneumonia. This may help for early initiation of first dose of parental antibiotics along with potassium supplementation before referral to tertiary hospitals by health workers to combat probability of deaths in such population especially in resource limited settings.
Highlights
Diarrhea and pneumonia are the two leading causes of morbidity and deaths among under-five children in developing countries [1,2]
Health workers in resource limited settings might miss the clinical signs of pneumonia in hypokalemic diarrheal children, delaying the initiation of appropriate antibiotics and potentially increasing the probability of deaths
Children whose caregivers did not give consent were not included in the study but still received standard hospital care. This data has been obtained from a prospective hospital audit which was initially designed to defend the thesis in Masters of Medicine (MMed) of the primary author in the University of Melbourne (UOM), Melbourne, Australia
Summary
Diarrhea and pneumonia are the two leading causes of morbidity and deaths among under-five children in developing countries [1,2]. Among the estimated 7.6 million global deaths in under-five children in 2010, pneumonia and diarrhea accounted for 18% and 11% of the deaths respectively [3]. These two are the common co-morbidities in under-five children with high morbidity and deaths in many developing countries [1,4]. Health workers in resource limited settings might miss the clinical signs of pneumonia in hypokalemic diarrheal children, delaying the initiation of appropriate antibiotics and potentially increasing the probability of deaths. It is very important to understand the influence of hypokalemia on the clinical features of radiological pneumonia in diarrheal children in order to develop guidelines for pneumonia diagnosis in such population and initiate appropriate management to reduce probability of deaths, especially in resource constraint settings. Our objective was to assess the influences of hypokalemia, and their outcome in such children
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