Diarrhea continues to be a major cause of hospitalization and death among children underfive. Electrolyte disturbances play an important role in the associated morbidity and mortality. Acute renal failure is one of the important complications of acute gastroenteritis in children. Earlyintervention and proper fluid replacement may lessen this risk.

A new study published in International Journal of Contemporary Pediatrics was designed toinvestigate the incidence of acute gastroenteritis and the status of associated electrolyte derangements and renal involvement.

In this cross-sectional study conducted at KIMS, Bengaluru, 117 children aged from 1 month to 5 years, with acute diarrhea, were included. Demographic profiles of the patients, details of diarrhea, clinical examination and accompanying degree of dehydration—defined as per WHO criteria—were recorded. Additionally, serum electrolytes along with renal parameters were investigated.

The 117 children with acute gastroenteritis constituted 5% of the total pediatric admissions. Findings showed that children aged 1-12 months had the highest incidence of diarrhea (50%). The male to female ratio was 1.3:1. Overall, 65% had some dehydration; 19% no dehydration; and 16% had severe dehydration. While isonatremia was seen in 58%, followed by hyponatremia in 35% and hypernatremia in only 7%. In addition, 83% had isokalemia, 12% had hypokalemia and 5% had hyperkalemia. Levels of serum-sodium and potassium decreased with the severity of dehydration. Whereas, serum urea and creatinine were significantly high in severe dehydration. Out of 28 children who were given diluted ORS before admission, majority had hyponatremia (39%),whereasall of them who received concentrated ORS had hypernatremia.

It was concluded that 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 acute gastroenteritis. Furthermore, measurements of serum electrolytes and renal parameters early can help in predicting the complications due to acute gastroenteritis and may aid in the prevention of diarrhea related complications in children.

The incidence of diarrhea peaks in children less than 1 year of age. Isonatremic dehydration was encountered commonly in children with acute diarrhea. The level of serum sodium and potassium decreased and ureaand creatinine increased with severity of dehydration.Hence, it was stated that timely recognition and correction of electrolyte disturbances, promotion of health awareness,breastfeeding, weaning with hygienically prepared foods,demonstration of how to prepare appropriate ORSsolution and better female literacy and health education are essential for reducing the morbidity and mortalityassociated with acute gastroenteritis.

Source: International Journal of Contemporary Pediatrics. 2020 Sep;7(9):1910-1917. doi: 10.18203/2349-3291.ijcp20203654