Insight into potassium's role in childhood mortality due to severe acute malnutrition.

Abstract

Hypokalaemia is associated with an increase in mortality in children with severe acute malnutrition (SAM) and diarrhoea. This is a descriptive cross-sectional retrospective study conducted in the Nutritional Ward at Mohamed Alamin Hamid Pediatrics Hospital in Omdurman, Sudan. It aimed to assess the frequency of hypokalaemia among children with SAM to understand the influence of hypokalaemia and potassium supplementations contributed on the children survival rates (January-December 2015). It included 215 patients with SAM and acute diarrhoea. The potassium levels of all the patients were assessed upon hospital admission and this correlated with the mortality according to the degree of hypokalaemia and treatment initiated. Hypokalaemia was evident in 70.2% of the patients. Mortality was 3.1% in normokalaemic and 13.9% in hypokalaemic patients. The patients' survival was significantly associated with their serum potassium levels and the treatment received. The survival rates have been assessed via the Multinomial Logistic Model, which reveals that normokalaemic children had a chance of 157.349 (95% confidence interval 18.479-1,339.811) times higher than that compared to the baseline children with advanced hypokalaemia with serum levels <2 mEq/l (p-value < 0.001). Children with mild hypokalaemia within the serum levels of 3.0-3.4 mEq/ml showed an increased survival chance of 549.970 (95% CI 19.293-3,238.716) times compared to the baseline children (p-value = 0.000). In patients with SAM, who presented with acute diarrhoea, there was an increase in mortality in patients with hypokalaemia compared with patients who presented with normal potassium levels. Corresponding mortality rates increased significantly with the severity of hypokalaemia. In severe hypokalaemia, there is a significant difference in mortality between patients treated with oral rehydration solutions for malnutrition in relation to patients treated with oral potassium supplements or with intravenous potassium.