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[Children hospitalized with acute gastro-enteritis. I. Electrolyte imbalances seen primarily in clinical dehydration]
1Sint Joseph Ziekenhuis, afd. Kindergeneeskunde, Veldhoven.
Insights
Routine electrolyte testing in children with acute diarrhea is often unnecessary. Abnormalities are rare and rarely impact treatment, especially in non-dehydrated children.
Area of Science:
- Pediatric Gastroenterology
- Clinical Chemistry
- Internal Medicine
Context:
- Acute diarrhea is a common pediatric illness.
- Electrolyte disturbances can be a complication of dehydration.
- Previous studies have varied on the necessity of routine lab testing.
Purpose:
- To assess the frequency of electrolyte disturbances in children with acute diarrhea.
- To determine if laboratory findings influenced therapeutic decisions.
- To evaluate the clinical utility of routine electrolyte and blood gas analysis in this population.
Summary:
- A retrospective review of 265 children with acute diarrhea found 28% were clinically dehydrated.
- Abnormal electrolyte values (Na, K, urea, creatinine, base excess) were more common in dehydrated children, predominantly isonatremic dehydration.
- Most abnormal values normalized with rehydration, with only one case of hypokalemia altering treatment.
Impact:
- The findings suggest that routine electrolyte, urea, creatinine, and blood gas testing is not indicated for all children with acute diarrhea.
- Laboratory investigations should be reserved for dehydrated children.
- Even in dehydrated children, abnormal values are infrequent and seldom necessitate changes in management.
Objective:
To determine how often electrolyte disturbances occurred in children with acute diarrhoea and whether these findings had therapeutic consequences.
Design:
Retrospective.
Method:
The hospital records of 265 children (152 boys and 113 girls; mean age: 1 year and 9 months (range: 1 month-12 years)) admitted with acute diarrhoea during the period 1992-1996 to the department of Paediatrics of Sint Joseph Ziekenhuis, Veldhoven, the Netherlands, were examined for abnormal laboratory values of Na, K, urea, creatinine and base excess. It was also determined if dehydration was present and if the findings affected the treatment. The therapeutic protocol included administration of a rehydration fluid if the child did not drink well; the own nutrition was resumed after 4-6 hr.
Results:
74 of the children admitted (28%) were clinically dehydrated. Abnormal laboratory values were found mainly (38/47) among these children. The majority (68; 92%) had isonatraemic dehydration. Most of the abnormal laboratory values normalised after rehydration. Only in the one case of hypokalaemia did this lead to a change in the composition of the rehydration fluid.
Conclusion:
Routine determination of electrolytes, urea, creatinine and blood gas is not necessary in all children with acute diarrhoea. These laboratory measures should be restricted to dehydrated children. Even then abnormal laboratory values are few and seldom have therapeutic consequences.