Abstract
Aim: to evaluate the spectrum of co-morbidities in severe acute malnutrition with unexpected dyselectrolytemia in diarrhea.
 Material and methods: The study was an observational study which was carried in the Department of pediatrics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga Bihar, India for 2 years. after taking the approval of the protocol review committee and institutional ethics committee. Total 200 Children below 5 year age were included in this study. Various co morbid conditions in study population were identified. All the laboratory examination was done with standard method.
 Results: Total 200 cases were included in study of which 96% were associated co-morbid conditions in SAM. Majority of children with SAM were having co-morbidity in the form of Anaemia (88%), Diarrhoea (60%) followed by pneumonia (32%), Rickets (31%), Tuberculosis (14%), Otitis media (12%), UTI (11%), Celiac (4%), Hypothyroidism (2%), & HIV (1%). Mean age (SD) of the diarrheal cases was 25(6) months (95% C.I. 24.1- 25.8) of which 70 were male (58.33%). Mean age (SD) of non-diarrheal cases was 19(6). (95% C.I. 16.6 – 19.4) of which 45 were male(75%). 120 (60%) SAM children presented with diarrhea of which 117 had dysnatremia in the form of Hyponatremia in 117 cases (58.5%) & Hypernatremia in 3 cases (1.5%) No statistically significant difference was found with hyponatremia in diarrheal or non-diarrheal cases of SAM (P value of 0.07). It was found that 20% SAM children were having hypokalemia. Hypokalemia was found in 15% of diarrheal cases & 5% in non- diarrheal cases. A statistically significant difference was found with hypokalemia in SAM (P value of 0.019) between Diarrheal & Non diarrheal cases. Conclusion: Dyselectrolytemia is high in complicated SAM and mainly sodium disturbances in form of hyponatremia are common in different co-morbid conditions.
 Keywords: Co-morbidities, Dyselectrolytemia, Potassium, Severe acute malnutrition, Sodium
Highlights
As per National Family Health Survey (NFHS)-4, the prevalence of severe acute malnutrition (SAM) has increased from 6.45 to 7.5% in children under 5 years of age in India.[1]
Mean age (SD) of non-diarrheal cases was 19(6). (95% C.I. 16.6 – 19.4) of which 45 were male(75%). 120 (60%) SAM children presented with diarrhea of which 117 had dysnatremia in the form of Hyponatremia in 117 cases (58.5%) & Hypernatremia in 3 cases (1.5%) No statistically significant difference was found with hyponatremia in diarrheal or nondiarrheal cases of SAM (P value of 0.07)
It was found that 20% SAM children were having hypokalemia
Summary
As per National Family Health Survey (NFHS)-4, the prevalence of severe acute malnutrition (SAM) has increased from 6.45 to 7.5% in children under 5 years of age in India.[1]. SAM children without complications are managed in community with Ready to Use Therapeutic Food (RUTF) which is enriched with minerals and micronutrients.[6] In our country, as RUTF is not available, children are advised home-based energy dense food along with micronutrient supplements. Their diet may still be deficient in minerals. This study aims to find out the incidence of dyselectrolytemia (Na+ and K+) in malnourished children
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