Early management of hypokalaemia in severely malnourished children under five could help to reduce deaths in developing countries
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Abu Sadat Mohammad Sayeem Bin Shahid1, Tahmina Alam1, Lubaba Shahrin1
1Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Insights
Hypokalaemia in severely malnourished children is linked to poor socio-economic status, diarrhea, and lower pulse rates. Early identification of these factors can improve outcomes and reduce mortality in pediatric malnutrition.
Area of Science:
- Pediatric Nutrition
- Clinical Medicine
- Public Health
Background:
- Hypokalaemia (low potassium) is a critical complication in severely malnourished children.
- Understanding associated factors is vital for improving treatment and reducing mortality.
Purpose of the Study:
- To evaluate factors associated with hypokalaemia in severely malnourished children under five years of age.
- To assess the outcomes of hypokalaemia in this vulnerable population.
Main Methods:
- A case-control study involving 407 severely malnourished children under five.
- Cases (n=139) had hypokalaemia; controls (n=268) did not.
- Data collected on clinical signs, laboratory parameters, socio-economic status, and treatment outcomes.
Main Results:
- Hypokalaemia was associated with older age, poor socio-economic status, and higher mortality (12% vs 7%).
- Clinical signs included diarrhea, lethargy, and lower pulse rates; laboratory findings included hyponatraemia, metabolic acidosis, hypocalcaemia, hypomagnesaemia, and leucocytosis.
- Independent factors associated with hypokalaemia were poor socio-economic status, diarrhea, lower pulse rates, hypocalcaemia, metabolic acidosis, and leucocytosis.
Conclusions:
- Early identification of clinical signs (diarrhea, lower pulse rates) and laboratory parameters (hypocalcaemia, metabolic acidosis) is crucial for managing hypokalaemia.
- Prompt management can significantly reduce morbidity and mortality in severely malnourished children.
Aim:
This study evaluated the factors associated with hypokalaemia and their outcomes, in severely malnourished children under 5 years of age.
Methods:
We focused on 407 severely malnourished children under five who were admitted to the Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh, from April 2011 to June 2012. The cases were 139 with hypokalaemia, and the comparisons were 268 without hypokalaemia.
Results:
Cases were older than the comparisons, with a poor socio-economic status and a higher death rate of 12% vs 7%. They were more likely to present with a history of measles, diarrhoea, lethargy, lower pulse rates, hyponatraemia, metabolic acidosis, hypocalcaemia, hypomagnesaemia, higher height or length, severe underweight, severe wasting and leucocytosis on admission. At discharge, cases had lower potassium levels and a higher proportion had persistent hypokalaemia. Cases received longer treatment with ampicillin and micronutrients. After adjusting for confounders, hypokalaemia was independently associated with poor socio-economic status, diarrhoea, lower pulse rates, hypocalcaemia, metabolic acidosis and leucocytosis.
Conclusion:
Identifying simple clinical signs, like diarrhoea and lower pulse rates, and laboratory parameters, such as hypocalcaemia and metabolic acidosis, may enable the early management of hypokalaemia in severely malnourished children under 5 years. This could reduce morbidity and mortality.
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