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Chan e e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
65
O iginal Resea ch A icle
Clinical P o ile and Ou come o Elec oly e Dis u bances in Child en Aged
I Mon h ο 12 Yea s in Pedia ic In ensi e Ca e Uni o a Te ia y Ca e
Hospi al
Alpana Chan e1, Ani ban Manna2, Fazlul Haque3, Syamal Kuma Bandyopadhyay4
1Senio Residen , MBBS, MD Paedia ics, Depa men o Paedia ics, Calcu a Na ional Medical College
and Hospi al, 32, Go achand Road, Beniapuku , Kolka a 700014
2Senio Residen , MBBS, MD Paedia ics, Depa men o Paedia ics, Calcu a Na ional Medical College
and Hospi al, 32, Go achand Road, Beniapuku , Kolka a 700014
3Senio Residen , MBBS, MD Paedia ics, Depa men o Paedia ics, Calcu a Na ional Medical College
and Hospi al, 32, Go achand Road, Beniapuku , Kolka a 700014
4P o esso , MBBS, DCH, MD Paedia ics, Depa men o Paedia ics, Calcu a Na ional Medical College
and Hospi al, 32, Go achand Road, Beniapuku , Kolka a 700014
Recei ed: 01-06-2025 / Re ised: 16-07-2025 / Accep ed: 25-08-2025
Co esponding Au ho : D . Syamal Kuma Bandyopadhyay
Con lic o in e es : Nil
Abs ac
In oduc ion: The ea men o di e en elec oly e imbalances is an essen ial componen o li e-suppo ing
ca e in an in ensi e ca e uni , especially o young pa ien s. Pedia ic in ensi e ca e uni s equen ly expe ience
elec oly e imbalances.
Aims: To e alua e he elec oly e imbalance end in pedia ic c i ical ca e. o de e mine he many causes o
elec oly e imbalances. To e alua e how elec oly e imbalances a ec mo ali y, leng h o PICU admission, and
a e e ec s.
Ma e ials & Me hods: This was a p ospec i e, obse a ional coho s udy conduc ed in he Depa men o
Pedia ic Medicine a Calcu a Na ional Medical College and Hospi al, a e ia y ca e cen e . The s udy was
ca ied, om 2021 o 2022, and included a o al o 150 pedia ic pa ien s.
Resul : In 38 pa ien s (25%) in ou in es iga ion, dyselec oly emia was mos equen ly seen as mixed
abno mali ies. 36 pa ien s (24%), 32 pa ien s (21%), and 27 pa ien s (18%) had hypona emia, me abolic
acidosis, and hypokalemia, espec i ely. Hype kalemia (12 pa ien s, 8%), hypocalcemia (9 pa ien s, 6%),
hype na emia (6 pa ien s, 4%), and hype calcemia (5 pa ien s, 3%), we e less common anomalies. (p<
0.00001) I was s a is ically signi ican .
Conclusion: We concluded ha he bulk o he 150 pedia ic pa ien s in ou s udy who we e admi ed o he
PICU we e male newbo ns be ween he ages o one mon h and one yea . Cen al ne ous sys em in ec ions
we e he mos common unde lying cause, and mixed elec oly e imbalances we e he mos commonly ound.
Keywo ds: PICU, Hype na emia, Hypokalaemia, Me abolic acidosis and Mo ali y.
This is an Open Access a icle ha uses a unding model which does no cha ge eade s o hei ins i u ions o access and dis ibu ed unde
he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/4.0) and he Budapes Open Access
Ini ia i e (h p://www.budapes openaccessini ia i e.o g/ ead), which pe mi un es ic ed use, dis ibu ion, and ep oduc ion in any medium,
p o ided o iginal wo k is p ope ly c edi ed.
In oduc ion
The ea men o di e en elec oly e imbalances is
an essen ial componen o li e-suppo ing ca e in an
in ensi e ca e uni , especially o young pa ien s.
Pedia ic in ensi e ca e uni s equen ly expe ience
elec oly e imbalances. They equen ly sha e
clinical cha ac e is ics o unde lying diso de s,
which calls o a high index o suspicion e en
hough hey don' always exhibi pa icula
symp oms. [1]. When c i ically ill pedia ic pa ien s
a e admi ed o pedia ic in ensi e ca e uni s
(PICUs), elec oly e imbalances a e a equen and
se ious consequence. These imbalances a e
equen ly caused by he apeu ic in e en ions,
unde lying disease p ocesses, o a mix o he wo.
Main aining cellula homeos asis, ne e
conduc ion, muscula unc ion, and acid-base
balance all depend on elec oly es like sodium,
po assium, calcium, and bica bona e. Any change
in hei concen a ion has he po en ial o
nega i ely impac se e al o gan sys ems and ha e a
signi ican impac on pa ien ou comes [2,3].Due o
hei de eloping physiology, limi ed physiological
ese es, and he se e i y o hei unde lying
illnesses, child en—especially hose be ween he
ages o one mon h and wel e a e mo e suscep ible
o elec oly e imbalances. These abno mali ies a e
equen ly b ough on by condi ions like sepsis,
dehyd a ion, in ec ions o he cen al ne ous
In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch e-ISSN: 0976-822X, p-ISSN: 2961-6042
Chan e e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
66
sys em, enal ailu e, and gas oin es inal diseases
[4]. Fu he mo e, he elec oly e balance o hese
pa ien s may become much mo e complica ed i IV
luids, diu e ics, and o he d ugs a e used in he
PICU [5]. Among he mos common sodium
abno mali ies seen in pedia ic c i ical ca e a e
hypona emia and hype na emia. A se um sodium
le el below 135 mEq/L is known as hypona emia,
and i can esul in neu ological symp oms anging
om mode a e diso ien a ion o seizu es and, in
ex eme and acu e cases, coma. On he o he hand,
because i a ec s b ain dehyd a ion and cellula
mal unc ion, hype na emia—a blood sodium le el
exceeding 145 mEq/L—is linked o signi ican
mo ali y and mo bidi y a es. To a oid
neu ological consequences and mo ali y, hese
illnesses need o be closely wa ched and ea ed
p omp ly. Hypokalemia and hype kalemia a e wo
equally impo an po assium abno mali ies. While
hype kalemia can esul in po en ially a al ca diac
a es i le un ea ed, hypokalemia can cause
espi a o y ailu e, ca diac a hy hmias, and muscle
weakness.Ano he common elec oly e- ela ed
dis u bance ha has impo an p ognos ic
implica ions in pedia ic c i ical illness is me abolic
acidosis, which equen ly esul s om sepsis, enal
ailu e, o diabe ic ke oacidosis. The pu pose o he
s udy is o e alua e he elec oly e dis u bance
pa e n in pedia ic in ensi e ca e. To de e mine he
many causes o elec oly e imbalances. To e alua e
how elec oly e imbalances a ec mo ali y, leng h
o PICU admission, and a e e ec s.
Ma e ials and Me hods
Type o s udy: This was a p ospec i e,
obse a ional coho s udy.
Place o s udy: Depa men o Pedia ic Medicine,
a Calcu a Na ional Medical College and Hospi al.
S udy Du a ion: App oxima ely one yea , om
2021 o 2022.
Sample Size: 150 Paedia ic pa ien s
Inclusion C i e ia: Child en aged be ween 1
mon h and 12 yea s who we e admi ed o he
PICU we e included in he s udy.
Exclusion C i e ia: Pa ien s we e excluded i hey
had congeni al anomalies, known me abolic
diso de s, neph o ic synd ome, ch onic diseases, o
had ecei ed luids and elec oly es p io o
admission.
S udy Va iables
• Elec oly e dis u bances we e iden i ied a he
ime o admission h ough de ailed his o y-
aking, which included in o ma ion on age,
sex, chie complain s, and ele an pas
medical his o y.
• Labo a o y e alua ion included se um le els o
sodium, po assium, calcium, and a e ial blood
gas (ABG) analysis. Elec oly e imbalances
we e classi ied based on s anda d e e ence
anges o each pa ame e .
• Special medica ions
• Mechanical en ila ion
• Ino opic suppo
S a is ical Analysis: Da a we e en e ed in o Excel
and analyzed using SPSS and G aphPad P ism.
Nume ical a iables we e summa ized using means
and s anda d de ia ions, while ca ego ical a iables
we e desc ibed wi h coun s and pe cen ages.
Two-sample - es s we e used o compa e
independen g oups, while pai ed - es s accoun ed
o co ela ions in pai ed da a. Chi-squa e es s
(including Fishe ’s exac es o small sample
sizes) we e used o ca ego ical da a compa isons.
P- alues ≤ 0.05 we e conside ed s a is ically
signi ican .
Resul
Table 1: Age Dis ibu ion o Child en wi h Elec oly e Dis u bances
Age G oup
Numbe o Pa ien s (n)
Pe cen age (%)
P - alue
1 mon h – 1 yea
75
50.00%
< .00001
>1 yea – 5 yea s
45
30.00%
>5 yea s – 12 yea s
30
20.00%
To al
150
100%
Table 2: Sex Dis ibu ion o Child en wi h Elec oly e Dis u bances
Sex
Numbe o Pa ien s (n)
Pe cen age (%)
P- alue
Male
85
56.70%
0.02088
Female
65
43.30%
To al
150
100%
Table 3: Incidence o Dyselec oly emia among s udy subjec s
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Chan e e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
67
Dyselec oly emia
Numbe o Pa ien s
Pe cen age
P- alue
Hypona emia
36
24%
< .00001
Hype na emia
6
4%
Me abolic Acidosis
32
21%
Hypokalemia
27
18%
Hype kalemia
12
8%
Hypocalcemia
9
6%
Hype calcemia
5
3%
Mixed abno mali ies
38
25%
To al
150
100%
Table 4: Unde lying illness in child en wi h Dyselec oly emia
Unde lying illness
Numbe o Pa ien s
Pe cen age
p- alue
Cen al ne ous sys em in ec ions
107
71%
< .00001
Respi a o y diseases
23
15%
Renal diseases
11
7%
Sep icemia
33
22%
Gas oin es inal diseases
11
7%
Mul i sys em in ol emen
33
22%
To al
150
100%
Table 5: Associa ion be ween ou come o child en wi h dyselec oly emia: G oup
Dyselec oly emia
Su i al
Deceased
P alue
Hypona emia
14 (58.4%)
10 (41.6%)
0.025
Hype na emia
1 (25%)
3 (75%)
<0.001
No mona emia
59 (82%)
13 (18%)
0.02
Hypokalemia
11 (61%)
7 (39%)
0.02
Hype kalemia
3 (37.5%)
5 (62.5%)
0.01
No mokalemia
60 (81%)
14 (19%)
—
Hypocalcemia
3 (50%)
3 (50%)
<0.022
Hype calcemia
3 (100%)
0 (0%)
—
No mocalcemia
68 (75%)
23 (25%)
—
Me abolic acidosis
13 (62%)
8 (38%)
<0.001
Figu e 1: Unde lying illness in child en wi h Dyselec oly emia
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Chan e e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
68
Figu e 2: Associa ion be weenou come o child en wi h dyselec oly emia: G oup
In ou s udy o he pa ien s in ou s udy, 75 (50%)
we e be ween he ages o one mon h and one yea ,
45 (30%) we e be ween he ages o one and i e,
and 30 (20%) we e be ween he ages o i e and
wel e. (p< 0.00001) I was s a is ically
signi ican . The majo i y o he 150 pedia ic
pa ien s wi h elec oly e abno mali ies in ou s udy
we e male (85, o 56.7%), wi h 65 (43.3%) being
emale. A p = 0.02088, i was s a is ically
signi ican . In 38 pa ien s (25%) in ou
in es iga ion, dyselec oly emia was mos
equen ly seen as mixed abno mali ies. 36 pa ien s
(24%), 32 pa ien s (21%), and 27 pa ien s (18%)
had hypona emia, me abolic acidosis, and
hypokalemia, espec i ely. Hype kalemia (12
pa ien s, 8%), hypocalcemia (9 pa ien s, 6%),
hype na emia (6 pa ien s, 4%), and hype calcemia
(5 pa ien s, 3%), we e less common anomalies. (p<
0.00001) I was s a is ically signi ican . In ec ions
o he cen al ne ous sys em accoun ed o 107
indi iduals (71%), ollowed by espi a o y
diso de s in 23 pa ien s (15%) and enal diso de s
in 11 pa ien s (7%). Thi y- h ee pa ien s (22%
each) had sep icemia and mul i-sys em
in ol emen , while ele en pa ien s (7% each) had
gas oin es inal diso de s. (p< 0.00001) I was
s a is ically signi ican . Di e en kinds o
dyselec oly emia ha e di e en su i al a es in
ou s udy. Hype na emia had he highes mo ali y
a e (75%, p < 0.001), while no mokalemia and
no mona emia had he highes su i al a es (82%
and 81%). Hype kalemia and hypocalcemia we e
linked o g ea e dea h a es (50–62.5%), while
hypona emia, hypokalemia, and me abolic acidosis
had mode a e su i al a es (58–62%). E e y
hype calcemic pa ien li ed. The e was s a is ical
signi icance in hese di e ences.
Discussion
In ou s udy, ou o 150 pa ien s mos o he
pa ien s we e 1 mon h – 1 yea yea s old [75
(50.0%)] which was s a is ically signi ican (p<
.00001).In simila s udy by This is consis en wi h
se e al s udies epo ing ha in an s wi hin his age
g oup ep esen he highes p opo ion o pedia ic
in ensi e ca e admissions. Singh e al. [6] (2018)
ound ha 48% o PICU admissions we e in an s
aged 1 mon h o 1 yea . Simila ly, Gup a e al. [7]
(2019) epo ed 52% o admissions in his age
ange, emphasizing hei ulne abili y.
We ound ha , male popula ion was highe [85
(56.7%)] han he emale popula ion [65(43.3%)].
Male: Female a io was 1.3:1 bu his was
s a is ically signi ican (p=0.02088).In o he s s udy
byLee OJ e al. [8] (2017) also showed male
p edominance wi h 59% and 54% espec i ely.
We obse ed ha mixed elec oly e abno mali ies
we e obse ed in he highes numbe o pa ien s—
38 ou o 150 (25%). This was s a is ically
signi ican (p < 0.00001) In simila s udy
Fe nandez e al. [9](2021) no ed 26% mixed
elec oly e diso de s in a mul icen e s udy. We
ound ha cen al ne ous sys em in ec ions we e
p esen in he highes numbe o pa ien s 107 ou o
150 (71%) I was s a is ically signi ican (p <
0.00001).
In o he s udy by Gup a e al.[10] (2019) ound
CNS in ec ions in 70% o hei coho . We
obse ed ha no mona emia was p esen in 72
pa ien s, wi h 59 (82%) su i ing and 13 (18%)
deceased (p = 0.02), while no mokalemia was seen
in 74 pa ien s, wi h 60 (81%) su i ing and 14
(19%) deceased, indica ing be e ou comes wi h
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Chan e e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
69
no mal sodium and po assium le els. All 3 pa ien s
wi h hype calcemia su i ed. In con as ,
hype na emia was associa ed wi h he highes
mo ali y, whe e 3 ou o 4 pa ien s (75%) died (p <
0.001).
Simila ly, hype kalemia showed high mo ali y
wi h 5 ou o 8 pa ien s (62.5%) deceased (p =
0.01). Among 24 pa ien s wi h hypona emia, 10
(41.6%) died (p = 0.025), and in 18 pa ien s wi h
hypokalemia, 7 (39%) we e deceased (p = 0.02).
Me abolic acidosis was p esen in 21 pa ien s, wi h
8 dea hs (38%) (p< 0.001), while hypocalcemia,
seen in 6 pa ien s, had an equal spli o 3 su i o s
and 3 deceased (p < 0.022). These indings indica e
ha hype na emia and hype kalemia we e s ongly
associa ed wi h inc eased mo ali y, whe eas
no mal elec oly e le els we e linked o be e
su i al ou comes.
Conclusion
We concluded ha analysis o 150 pedia ic
pa ien s admi ed o he PICU e ealed ha mos o
hem we e male newbo ns be ween he ages o one
mon h and one yea . Cen al ne ous sys em
in ec ions we e he mos common unde lying
cause, and mixed elec oly e imbalances we e he
mos commonly ound. While no mona emia and
no mokalemia we e linked o imp o ed ou comes,
elec oly e imbalances, especially hype na emia
and hype kalemia, we e s ongly linked o
inc eased mo ali y. These esul s highligh how
c ucial i is o iden i y elec oly e abno mali ies in
c i ically ill in an s ea ly, moni o hem equen ly,
and ea hem p omp ly. In he pedia ic in ensi e
ca e uni , iden i ying high- isk g oups can aid in
enhancing clinical esul s, lowe ing mo ali y, and
di ec ing sui able managemen echniques.
Re e ence
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o Elec oly e Dis u bances in child en aged 1
mon h o 12 yea s T ea ed in Pedia ic
In ensi e Ca e Uni o a Te ia y Ca e
Hospi al' MD. Ins i u e O Child Heal h And
Hospi al Fo Child en, Chennai. 2008.
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Elec oly e dis u bances in c i ically ill
child en admi ed o PICU and hei ou comes.
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