FREQUENCY AND OUTCOMES OF ELECTROLYTE IMBALANCE IN CRITICALLY ILL PEDIATRIC PATIENTS ADMITTED TO A PUBLIC-SECTOR PICU IN KARACHI, PAKISTAN

Abstract

Background: Electrolyte imbalances are a known cause of morbidity and mortality in critically ill pediatric patients. However, there is a lack of data on their prevalence and prognostic impact in Pakistan's public-sector intensive care units.

The goal was to identify the frequency, types, and clinical outcomes of electrolyte imbalances in children admitted to a public-sector PICU in Karachi, Pakistan.

Methods: We carried out a prospective cross-sectional study at the National Institute of Child Health (NICH) in Karachi from January to June 2024. Consecutive admissions (n = 205) ranging in age from one month to thirteen years were evaluated. Serum electrolytes (Na⁺, K⁺, Ca²⁺, P, Mg) were measured upon admission, and any imbalances were defined using pediatric reference ranges. The primary outcome was PICU mortality; secondary outcomes included length of stay. Multivariable logistic regression with adjustments for age, gender, and admission diagnosis.

Results: Overall, 118/205 patients (57.6%) had at least one electrolyte abnormality upon admission (Table 2). The most prevalent disturbances were hypocalcemia (19.5%), hyponatremia (14.6%), hypokalemia (12.2%), and hypomagnesemia (8.8%) (Table 2). Infants aged 1 to 12 months had the highest imbalance prevalence (65.1% vs. 49.1% in older children; p = 0.002). Children with electrolyte disturbances had a higher mortality rate of 21.2% compared to 5.7% without (p < 0.001). A multivariable analysis found that having ≥2 electrolyte derangements increased the risk of death (OR 3.2; 95% CI 1.7-6.1; p = 0.001). The imbalance group had a significantly higher median PICU stay (5.2 days vs. 3.4 days; p < 0.01).

Conclusion: Electrolyte imbalances are common (≈58%) among critically ill children in this public-sector PICU and independently predict mortality and prolonged ICU stay. Routine, early electrolyte monitoring and standardized correction protocols are critical for improving outcomes in similar low-resource settings.