Conference abstract

Detection and management of hypokalemia, Alima/Befen Pediatric Hospital, Mirriah, Niger, July 2017

Pan African Medical Journal - Conference Proceedings. 2018:9(19).13 Dec 2018.
doi: 10.11604/pamj-cp.2018.9.19.746

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Keywords: Malnutrition, diarrhea, hypokalemia

Detection and management of hypokalemia, Alima/Befen Pediatric Hospital, Mirriah, Niger, July 2017

Antoine Maillard1,&, Ali Ahmed Moulaye1, Baweye Mayoum Barka1, Fatoumata Binta Diaoune1, Susan Shepherd1

1Alliance for International Medical Action (ALIMA), Mirriah, Niger

&Corresponding author
Antoine Maillard, Alliance for International Medical Action (ALIMA), Mirriah, Niger


Introduction: serum electrolytes are commonly used in industrialized countries to manage severely dehydrated and critically ill children, but this diagnostic too is rarely available in pediatric humanitarian projects. Nonetheless, electrolyte disorders are common in these contexts, in particular in malnourished children, where hypokalemia is frequent and associated with the occurrence of death. This work aims to document the prevalence of electrolyte disturbances at admission and during hospitalization, and pilot the efficacy and tolerance of a protocol for management of hypokalemia.

Methods: the inclusion criterias were children over 3kg with diarrhea and/or vomiting and MUAC greater than 115mm. Exclusion criteria: = 3 second capillary refill time, edema. We excluded SAM patients (MUAC < 115mm due the risk of fluid overload and the absence of any recommendation for potassium correction in this population). An ionogram (iSTAT EC8+) was performed at admission and then every 12 hours until documentation of a serum potassium > 2.5mmol/L. Concurrently, rehydration and/or re-nutrition was carried out with a second ionogram measured before initiating a potassium correction (0.6mmol / kg over 3 hours) if [K +] < 2.5mmol/L.

Results: 20 children, 6 girls and 14 boys, including 9 pediatric cases and 11 nutritional cases (MUAC 115 - 124mm), hospitalized for malaria and/or gastroenteritis. We present the results separately for pediatric and nutritional cases, as pediatric cases do not benefit from the supply of therapeutic milk containing potassium. 14 children (70%) had hypokalemia, 8 of them severe. None had any specific clinical signs of hypokalemia. No significant differences between the first two serum potassium levels following standard management (therapeutic milk + resomal or SRO + ringer-lactate). 8 children (3 pediatric cases, 5 nutritional cases) received a potassium infusion and no adverse events were observed.

Conclusion: hypokalemia is known to be major issue in malnourished children: often severe and refractory to the intake of therapeutic milk or resomal. Hypokalemia also appears to be common in pediatric patients, where rehydration protocols do not take it into account. It remains to be determined to what extent correction of hypokalemia could improve the survival of these children. The main limit of this project is the small sample size, thus preventing us from detecting any differences between paediatrics and MAM patients or any association with outcome. These initial findings suggest it is important to further describe electrolyte imbalances in hospitalized children in humanitarian settings.