Study of electrolyte disturbances and renal parameters in acute gastroenteritis under 5 years of age in a tertiary care hospital of Bengaluru, India

Abstract

Background: Diarrhoea still continues to be a major cause of hospitalization and death in under fives. Electrolyte disturbances play an important role in the associated morbidity and mortality. Acute renal failure is one of the important complications of acute gastroenteritis (AGE) in children. Early intervention and proper fluid replacement may lessen this risk. This study was designed to find out the incidence of acute gastroenteritis and the status of associated electrolyte derangements and renal involvement.Methods: This was a cross sectional study conducted at KIMS, Bengaluru in which 117 children from the age of 1 month to 5 years with acute diarrhea were included based on a predefined inclusion and exclusion criteria. Demographic profile of the patients, details of diarrhea, clinical examination and accompanying degree of dehydration (defined as per WHO criteria) were recorded. Serum electrolytes along with renal parameters were investigated.Results: Total 117 children with acute gastroenteritis were enrolled in the study as per the inclusion criteria which constituted 5% of total paediatric admissions. Children aged 1-12 months had the highest incidence of diarrhea (50%). Male to female ratio is 1.3:1. 65% had some dehydration, 19% no dehydration and 16% had severe dehydration. Isonatremia was seen in 58% followed by hyponatremia in 35% and hypernatremia in only 7%. 83% had isokalemia, hypokalemia in 12%, hyperkalemia in 5%. Levels of serum sodium and potassium decreased with the severity of dehydration. Serum urea and creatinine were significantly high in severe dehydration (p value 0.001). Out of 28 children who were given diluted ORS before admission, majority had hyponatremia (39%) and all of them who received concentrated ORS had hypernatremia.Conclusions: Hyponatremic dehydration is the second most common type of dehydration next to isonatremic dehydration, but it is more common in children who took diluted ORS. Increased awareness regarding ORS preparation may help in preventing electrolyte imbalance in AGE. The levels of serum sodium and potassium decreased and urea and creatinine increased with severity of dehydration. Measurements of serum electrolytes and renal parameters early can help to predict the complications due to AGE and may help in the prevention of diarrhea related complications in children.

A study of serum electrolyte imbalances and its impact in children of 4 months to 5 years of age group presenting with acute gastroenteritis

“…Findings similar to that obtained by Pizzaro et al, Kocaglu et al and Shankar et al in their study found that those who given diluted ORS before admission, majority had hyponatremia (39%) and all of them who received concentrated ORS had hypernatremia. [10][11][12] Hence considering results of our study, serum electrolyte and acid base imbalances are a significant cause of morbidity and mortality in acute gastroenteritis related dehydration in children. Appropriate ORS administration and timely management of electrolyte imbalances are important in prevention of complications.…”

Navigating a Complex Presentation: Management of Hypernatremic Dehydration, Acute Kidney Injury, Hyperkalemia, and Metabolic Acidosis in a Patient With Down Syndrome: A Case Report

“…In refractory cases or cases with very severe hyperkalemia, hemodialysis remains the best modality to remove potassium from the body [14]. However, gastroenteritis is not a common cause of hyperkalemia, as mentioned previously [3,4]. Potassium and sodium concentration gradients are strictly maintained across the myocardial cells by ATPase pumps that pump sodium outside and potassium inside the cell, and this plays a vital role in maintaining cardiac rhythm.…”

“…According to a cross-sectional study conducted among 117 children with acute gastroenteritis in a tertiary care hospital in India, isonatremia was seen in 58%, followed by hyponatremia in 35%, and hypernatremia in only 7%. Furthermore, 83% had isokalemia, 12% had hypokalemia, and 5% had hyperkalemia [3]. Another retrospective, observational, hospital-based study done in Dhahran, Nepal involving 57 children with gastroenteritis and diarrhea showed metabolic acidosis in 15 (94%) while one (6%) had metabolic alkalosis, with similar estimations regarding sodium and potassium (hyponatremia: 56%, hypernatremia: 10%, hypokalemia: 46%, hyperkalemia: 3%) [4].…”

Gambaran Fungsi Ginjal pada Anak Penderita Diare dengan Dehidrasi di RSUP Prof. Dr. R. D. Kandou Manado

“…Hasil penelitian ini sejalan dengan beberapa penelitian lain yang menemukan kadar ureum serum normal pada anak diare dengan dehidrasi. [21][22][23] Beberapa hal yang dapat memengaruhi kadar ureum serum, di antaranya asupan protein dan status hidrasi. Peningkatan asupan protein sebagai bahan dasar akan meningkatkan pembentukan ureum di dalam tubuh sehingga kadar ureum serum akan meningkat.…”

“…Hal ini sejalan dengan beberapa penelitian lain yang melaporkan konsentrasi ureum serum cenderung meningkat bermakna pada dehidrasi berat. 20,22 Gambaran kreatinin serum pada penelitian ini ditemukan hanya seperempat kasus yang mengalami peningkatan dan sebagian besar lainnya dalam kadar normal. Hasil ini sejalan dengan penelitian lain yang melaporkan kadar kreatinin serum normal pada anak diare dengan dehidrasi.…”