Study of association of mortality with electrolyte abnormalities in children admitted in pediatric intensive care unit

Abstract

Background : Electrolyte abnormalities are common in critically ill children needing admission in intensive care unit. In view of the importance of electrolyte homeostasis and its significant impact on the final outcome of the patient, the present study was undertaken. Since sodium and potassium are the electrolytes that are most frequently deranged in critically ill patients, we have studied these electrolytes in our study. Methods : The study was carried out in the Pediatric Intensive Care Unit at a tertiary care hospital. The study enrolled all the patients admitted in PICU of age 29 days to 12 years during April 2015 to September 2017. Hyponatremia and hypernatremia was defined as serum sodium concentration below 135mEq/L and above 145mEq/L respectively. Hypokalemia and hyperkalemia shall be defined as potassium level below 3.5mEq/L and above 5.5mEq/L, respectively. Results : The prevalence of electrolyte abnormality in terms of sodium or potassium abnormality in our study was 44.31% (323 out of 729). Hyponatremia (27.43%) was the most common electrolyte abnormality in our study followed by hypokalemia (13.99%). The mortality in children with electrolyte abnormality was found to be 28.8% that was higher as compared to the mortality in the group without electrolyte abnormality which was 19.7%. This association was statistically significant (p value=0.004; Odd’s ratio- 1.640; 95% confidence interval 1.169-2.322).The mortality in the patients with hyponatremia and hypernatremia was 32.5% and 38.5% respectively, which was significantly higher than the mortality in the normonatremic patients which was 19.5%, the association being statistically significant. The mortality in the group with hypokalemia and hyperkalemia was found to be 24.5% and 30.4% which was higher than the group with normokalemia which was 23.1%. However, the association was not statistically significant. The association of primary organ system involvement with the presence of electrolyte abnormality was found statistically significant. Maximum number of study participants with hyponatremia had central nervous system involvement (48.5%) and those with hypernatremia had gastrointestinal system involvement (65.4%). Hypokalemia was most frequently observed in patients with gastrointestinal involvement (54.9%) and hyperkalemia with renal involvement (34.8%). Conclusion : Our study has demonstrated significant association of electrolyte abnormalities at admission in PICU with mortality and primary organ system involvement. Close monitoring and correction of electrolyte abnormalities is essential to reduce morbidity and mortality.