Serum Electrolyte Abnormalities as Prognostic Factor for Outcome in Critically Ill Children

Electrolyte imbalances are frequent and potentially life-threatening disturbances encountered in pediatric intensive care units (PICUs). These imbalances can reflect underlying pathological processes, treatment interventions, or both, and may influence the clinical course and outcomes of critically ill children. The homeostasis of electrolytes such as sodium, potassium, calcium, and magnesium plays a central role in cellular function, nerve conduction, and cardiovascular stability, making their monitoring and correction crucial during pediatric critical illness .

Studies have highlighted that disturbances like hyponatremia, hyperkalemia, or hypocalcemia often serve as early indicators of disease severity or progression. Kiran and Chaudhary[2021]observed that children admitted with electrolyte abnormalities frequently experienced higher morbidity and mortality compared to those without such disturbances, suggesting a direct correlation with outcomes in the PICU setting .

These abnormalities may arise from diverse etiologies, including dehydration, renal dysfunction, endocrinal disorder and hypothalamic disorder, sepsis, gastrointestinal losses, or medication effects Electrolyte derangements are particularly prevalent among pediatric patients presenting to emergency departments, with age-related differences in presentation and underlying causes. Yen et al. demonstrated that younger children were more prone to sodium and potassium imbalances due to immature renal handling and higher fluid turnover, while older children exhibited abnormalities associated with chronic illnesses or pharmacological agents .Recognizing these patterns can aid in risk stratification and individualized management strategies The spectrum of electrolyte emergencies in children is broad and necessitates rapid identification and intervention. Zieg et al. underscored that life-threatening complications such as arrhythmias, seizures, and cerebral edema often arise from untreated or mismanaged electrolyte disorders, especially in the PICU environment . Hence, early diagnosis and understanding of etiological factors are pivotal in improving clinical outcomes and preventing complications.

Local demographic and regional healthcare factors may also influence the incidence and types of electrolyte abnormalities. In a study from a tertiary care center, Routray et al. found significant variation in electrolyte imbalance profiles across different age groups and disease categories, emphasizing the importance of context-specific evaluation in pediatric populations . Such data are essential for tailoring protocols in resource-limited settings Recent studies such as the one by Rewers et al. on diabetic ketoacidosis have demonstrated that fluid rehydration strategies can impact the rate of correction of acidosis and electrolyte derangements. Their findings highlighted the importance of fluid composition and timing in achieving rapid stabilization without causing further complications . Such protocols are particularly relevant in pediatric patients with metabolic derangements Finally, the overall impact of electrolyte disorders on mortality in the PICU has been underscored in several investigations. Haider et al. found a statistically significant association between electrolyte imbalance and increased risk of death among critically ill children, stressing the need for early intervention and continuous monitoring as part of comprehensive PICU care .

Inclusion criteria

• Children aged 1 month to 18 years.
• Admission to the PICU for any acute medical or surgical reason.
• Availability of serum electrolyte data within the first 24 hours of admission

Exclusion criteria

• Children with known chronic kidney disease and chronic liver disease
• Patients with incomplete medical records or missing electrolyte data.
• Children discharged or deceased within 6 hours of admission.
• Patients with chronic liver diseases, or previously diagnosed with adrenal gland disorders