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Severe hypophosphatemia in children with kwashiorkor is associated with increased mortality
M J Manary1, C A Hart, M P Whyte
1Departments of Medicine, Pediatrics, and Genetics and the Division of Bone and Mineral Diseases, Washington University School of Medicine, St. Louis, Missouri, USA.
Insights
Severe hypophosphatemia (low phosphate levels) is common in children with kwashiorkor and significantly increases their risk of death. Early detection and management are crucial for improving outcomes in these vulnerable patients.
Area of Science:
- Pediatrics
- Nutritional Science
- Clinical Medicine
Background:
- Kwashiorkor is a severe form of malnutrition.
- Hypophosphatemia is a known complication of malnutrition.
- The prevalence and impact of severe hypophosphatemia in kwashiorkor are not well-established in all regions.
Purpose of the Study:
- To determine the incidence of severe hypophosphatemia in children with kwashiorkor.
- To assess the association between severe hypophosphatemia and mortality in these children.
- To identify clinical predictors of severe hypophosphatemia and mortality.
Main Methods:
- Prospective observational study of children admitted with kwashiorkor.
- Serum phosphate levels measured within 48 hours of admission.
- Clinical data including dermatosis and dehydration were recorded.
Main Results:
- Severe hypophosphatemia (serum phosphate <0.32 mmol/L) occurred in 12% of children with kwashiorkor.
- Mortality was significantly higher in children with severe hypophosphatemia (63%) compared to those without (22%).
- Dermatosis and dehydration were correlated with hypophosphatemia but not reliable predictors of fatal outcomes.
Conclusions:
- Severe hypophosphatemia is a common and life-threatening complication in children with kwashiorkor in Malawi.
- Clinical signs like dermatosis and dehydration are associated with hypophosphatemia but do not reliably predict mortality.
- Further research into the management of hypophosphatemia in kwashiorkor is warranted.
Abstract:
Severe hypophosphatemia, serum phosphate concentration <0.32 mmol/L (<1.0 mg/dL), occurred in 8 of 68 (12%) of children with kwashiorkor within 48 hours of admission; 5 of 8 (63%) of these children died, compared with 13 of 60 (22%) children without severe hypophosphatemia (P <.02). Dermatosis and dehydration were significantly correlated with severe hypophosphatemia, but these clinical signs could not reliably predict fatal cases. Severe hypophosphatemia seems to be common and life-threatening in children with kwashiorkor in Malawi.