Abstract:

Background: Electrolytes play a key role maintaining homeostasis along with fluids in pediatric patients. The higher and lower value of electrolytes like sodium, potassium, and chloride can affect cellular processes drastically as it may result in cardiac, respiratory, and neurological complications; hence increased morbidity and mortality of critically ill children. The aim of this study was to determine the prevalence, factors associated and short term outcome of electrolyte abnormalities in critically ill children admitted in PICU and HDU.

Methodology: This was a hospital-based cross-sectional study involving critically ill children who were admitted in pediatric intensive care unit (PICU) and high dependency unit (HDU) in the pediatrics department of the Bugando medical centre between September 2022 and February 2023. A data collection tool was used to record important information on the child’s history and a physical examination finding within 24 hours of admission. Blood samples were drawn for measurements of serum potassium, sodium and chloride using the chemistry analyzer Cobas Integra 400 plus. Statistical data analysis was performed using STATA version 13 and the p-value of <0.05 was used as a statistical level of significance.

Results: A total of 312 critically ill children at Bugando Medical Centre were enrolled. The their median age was 36[12-72] months and most of them were under five years of years of age 203(65%) and the majority was male 189 (61%). The most prevalent electrolyte derangement was hypochloremia (50.6%) followed by hypokalemia (32.4%) and both were independently associated with having severe acute malnutrition (p-value 0.04) and (p-value<0.001). Children with hyperkalemia and hyerchloremia had increased risk of dying within 48hrs while hypokalemia and hypernatremia were independently associated with prolonged stay in ICU.

Conclusion: Abnormalities of sodium, potassium, and chloride are very common in critically ill children, and they are mostly associated with severe acute malnutrition, being in a state of shock, having renal disease, convulsions, having sickle cell disease and diarrhea. The abnormalities were also independently associated with pronged ICU stay and death. These electrolytes should be closely monitored in ICU to reduce associated prolonged stay in ICU and mortality.