Study of Serum Electrolytes and Calcium Changes in Children with Severe Pneumonia and it’s Outcome

Abstract

Background: Electrolyte imbalance is one of the serious complications in hospitalized children with severe pneumonia. Monitoring of changes in electrolytes is very essential to prevent the complications leading to increased morbidity and mortality. Aims and objectives: To study serum electrolytes and calcium disturbances in patients with severe pneumonia. To identify relation of serum electrolytes with outcome of severe pneumonia. Material and Methods: After taking approval of ethics committee of our institute, we studied a total of hundred cases over a span of 24 months- August 2018 to December 2020. Study is carried out among cases of severe pneumonia and community acquired pneumonia (CAP) in age group of 2 months to 5 years admitted in pediatrics department of tertiary care centre in Maharashtra. Laboratory investigations of serum sodium, potassium, chloride and calcium levels were noted at admission and 24 hours after hospitalization. Results: This is observational cross study carried out in 100 children of severe pneumonia admitted in paediatric intensive care unit at Dr. Vasantrao Pawar Medical College, Nashik to observe and study electrolyte changes in them. Most children were in age group of 2 months to 12 months (i.e., 72%) followed by 28% in age group of 13 months to 60 months. At admission most common abnormality was hypocalcemia 49% followed by hyponatremia 27%, hyperchloremia 7%, hyperkalemia 6%, hypernatremia 6%, hypokalemia 4%, hypochloremia 1%. After 24 hours of stabilization hyponatremia was most common 40%, followed by hapocalcemia 43%, hypokalemia 9%, hypernatremia 8%, hyperkalemia 4%, hyperchloremia 4%. Conclusion: Mortality was significantly higher in cases with chloride level abnormality than with normal chloride level. Cases with disturbances in electrolytes showed higher mortality than those without electrolyte disturbances. Hyponatremia and hypokalaemia were associated with adverse outcomes in pneumonia cases. Electrolyte disturbances are commonly seen in pneumonia cases, so we should monitor them properly while treating them to avoid complications. Hyponatremia in pneumonia occurs due to Syndrome of Inappropriate Anti Diuretic Hormone secretion (SIADH). Hyponatremia at admission significantly affect outcome in terms of prolonged duration of hospitalization and two fold increase in mortality.