A study of biochemical abnormalities among children suffering from Acute diarrhea

 

 

Abstract               Background: The average incidence of diarrhea among under five children per year in most of the developing countries is 3.2 episodes of diarrhea per child per year and the mortality of 4.9/1000 episodes per year. Diarrhea alone results in nearly 21% of the all the death in the under five years’ children. Diarrhea is defined as passage of 3 or more loose or watery stools in 24-hour period that would take up the shape of the container6. It is also defined as a recent change in consistency and character of stool with a frequency of 3 or more liquid stools per day. Objective: To assess the level of biochemical abnormalities among under five children admitted in a tertiary care hospital. Materials and Methods: A cross section study was conducted at Basaveshwara Medical College and Hospital From May 2018 to November 2018.All the children during the study period who were between the age group of 1 months to 5 years who were admitted in the pediatric ward with history of. diarrhea were included in the study. A total of 160 cases were included in this study. Results: Majority (55%) of the study subjects were in the age group of less than 1 years and 10% between 1-2 years and 35% in the age group of 3-5 years. The frequency of loose stools less than 3 episodes per day was seen in 19(12%), 107 (67%) had 3-10 episodes per day and 34 (21%) had more than 10 episodes of loose stools per day. The urea levels were less than 20 mg/dl in nearly 10(6%) of the subjects, 20-35 mg/dl in 110(69%) and > 35 mg/dl in nearly 40 (25%) of the subjects. The Creatinine level less than 0.4 mg/dl was seen in nearly 101(63%). Conclusion: Acute diarrhea in children is associated with high morbidity and mortality Most of the patients with transient hyponatremia and transient hypokalemia, treated with ORS. These patients did not show classical signs and symptoms of hyponatremia. and hypokalemia.

Key Word: Diarrhoea, Under five, Electrolytes, Biochemical

 

 

INTRODUCTION

One of the major public health problem resulting in mortality and morbidity in the pediatric age group is diarrhea. Diarrhea results in approximately 1.5-2.5 million deaths per year in the under five years’ age group.¹ The average incidence of diarrhea among under five children per year in most of the developing countries is 3.2 episodes of diarrhea per child per year and the mortality of 4.9/1000 episodes per year. Diarrhea alone results in nearly 21% of the all the death in the under five years’ children.² In Indian health institutions, up to a third of pediatric admissions are due to diarrheal diseases and up to 17%of all deaths in indoor pediatric patients are due to diarrhea. The morbidity rates in terms of diarrheal episodes per year, per child under 5 years is about,1.7. The proportionate mortality due to diarrhea in 0-6 yrs. of age is 9.1 %.³ Diarrhea is defined as passage of 3 or more loose or watery stools in 24-hourperiod that would take up the shape of the container6. It is also defined as a recent change in consistency and character of stool with a frequency of 3 or more liquidstools per day.⁴ Acute watery diarrhea is one which begins acutely, lasts for less than 14 days with passage of frequent loose/watery stools without visible blood or mucous. More than 90% of acute diarrhea is due to infectious agents.⁵ In addition, many time this number have long-term, lasting effects on nutritional status, growth, fitness, cognition, and school performance. Some studies have revealed the impact of diarrhea on growth. It is believed that diarrhea have a significant impact on growth due to reduction in appetite, altered feeding practices and decreased absorption of nutrients48.There was a marked negative relationship between diarrhea and physical growth and development of a child.^6,7,8 Electrolyte abnormalities are common in children with diarrhea. It may remain unrecognized and result in mortality and morbidity. Timely recognition, a high index of suspicion and thorough understanding of common electrolyte abnormalities is necessary to ensure their correction. The present work was undertaken to study the common electrolyte abnormalities in diarrhea and its impact on the mortality

 

MATERIALS AND METHODS

A cross section study was conducted at Basaveshwara Medical Colllege and Hospital From May 2018 to November 2018.All the children during the study period who were between the age group of 1 months to 5 years who were admitted in the pediatric ward with history of diarrhea were included in the study. A total of 160 cases were included in this study.

Cases with altered sensorium, Pneumonia and Gastroenteritis of more than 7 days’ duration were excluded in the study.

Detailed clinical examination was done to look for thirsty, irritability, pinched look, sunken eyes, dry inner side of cheeks, abdominal distention, deep and rapid breathing, weak and thready pulse, falling blood pressure, reduced quantity of urine according to WHO dehydration assessment scale. All the laboratory investigations were done and data was collected in a predesigned, pretested and semi-structured questionnaire.

 

RESULTS

A total of 160 cases were analyzed in our study.

Table 1: Sociodemographic variables in the study subjects

Majority (55%) of the study subjects were in the age group of less than 1 years and 10% between 1-2 years and 35% in the age group of 3-5 years. Nearly 53% of the study participants were Male and 47% were females in our study. The rural population were 109(68%) in our study and 51(32%) from urban areas. The study population belonged to lower socioeconomic status were higher when compared to higher socio economic group. Nearly 29(18%) of the study population weighed less than 5 kg and 46 % were between 5-10kg and nearly 36% weighed more than 10 kgs.

Table 2: Clinical Signs and Symptoms among the subjects

Dehydration was present in nearly 67(42%) of the study subjects during the time of admission and 45(28%) off them also presented with abdominal distension. The frequency of loose stools less than 3 episodes per day was seen in 19(12%), 107 (67%) had 3-10 episodes per day and 34 (21%) had more than 10 episodes of loose stools per day.

 

Table 3: Laboratory findings of the biochemical values

The urea levels were less than 20 mg/dl in nearly 10(6%) of the subjects, 20-35 mg/dl in 110(69%) and > 35 mg/dl in nearly 40 (25%) of the subjects. Blood Glucose levels was less than 65 mg/dl in nearly 36 (22%), 65-99 mg/dl seen in 110(69%) and 14 (9%) of them had more than 100 mg/dl. The total bilirubin level of less than <1.3 mg/dl in nearly 152(95%) of the children. The Creatinine level less than 0.4 mg/dl was seen in nearly 101(63%).

 

DISCUSSION

The Acute diarrheal disease is a major public health problem and a leading cause of pediatric morbidity and mortality. Among the children aged less than 5 years of age in developing countries the average episodes of loose stools were 3.2 episodes per child per year,² in our study the average episodes of stool per day was 6.2. The most common age group of children affected by diarrhea was more among the children less than 1 years of age in our study. The study findings of our study was similar to the study of Shah G S et al ⁹and in the prospective study done in UK.¹⁰ Rebecca Oketcho et al¹¹ and Shah G S et al⁹ also showed more male children than female children, which was similar to our study findings. The signs and symptoms of dehydration was seen in nearly 42 % of the study group, in the study done by Begum JA et al¹² and Wathen et al 13the percentage of children with dehydration were almost comparable with our study findings. In our study nearly 69% of children had normal glucose levels which is similar to the study findings of Subba Gangaraj et al.¹⁴ The urea levels were within normal limits was seen in nearly 69 % of the children and nearly 25 % of them had increased urea levels. In the study done by K R Purohit et al¹⁵ nearly 53 % of the children had increased both urea and creatinine levels. The mean sodium levels in our study were similar to the study findings of Subba Gangaraj¹⁴ and Shah G S et al.⁹ The Potassium levels in our study were similar to the study findings of K R Purohit .¹⁵

 

CONCLUSION

Acute diarrhea in children is associated with high morbidity and mortality Most of the patients with transient hyponatremia and transient hypokalemia, treated with ORS. These patients did not show classical signs and symptoms of hyponatremia. and hypokalemia. Like any other electrolyte abnormalities which occurs in conditions other than diarrhea, are basically asymptomatic and does not require aggressive correction of electrolytes. Early treatment with ORS and ant motility drugs has been associated with improvement in the children, to prevent morbidity and mortality. They do very well with ORS and fluid correction as recommended by W.H.O.

 

REFERENCES

1. Centers for disease control and prevention: Morbidity and mortality weeklyreport: Managing acute gastroenteritis among children .2003; 52: 56.
2. Bulletin of the World Health Organ: The global burden of diarrhealdisease. Geneva.2003;. 81(3).1-9.
3. National commission on macroeconomics’ and health: Estimation of the burden of diarrheal disease in India: 2004: P 182-187.
4. O P Ghai, Piyush Gupta,et al: Essential pediatrics: 6th Edition 2005: P 269-280.
5. David A Ahlquist, Michael Camilleri et al:Diarrhea and constipation: Harrison’s principles of internal medicine: 16th Edition, P 224-233
6. Patwari AK. Diarrhoea and malnutrition interaction. Indian J Pediatric. 1999; 66 (1): 124-34.
7. Checkley W, Epstein LD, Gilman RH, Cabrera L, Black RE. Effects of acute diarrhea on linear growth in Peruvian children. Am J Epidemiol. 2003; 157 (2):166-75.
8.  Moffat T. Diarrhea, respiratory infections, protozoan gastrointestinal parasites, and child growth in Kathmandu, Nepal. Am J Phys Anthropol.2003; 122(1):85-97.
9. Shah GS, Das BK, Kumar S, Singh MK, Bhandari GP Acid base and electrolyte disturbance in diarrhea. Kathmandu Univ Med J. 2007 ;5(1):60-2
10. Conway SP, Phillips RR, Panday S. Admission to hospital with gastroenteritis. Archives of Disease in Childhood 1990; 65:579–84.
11. Rebecca Oketcho, Esron D Karimuribo, Cornelio N M Nyaruhucha, Saifuddin Taybali Epidemiological factors in admissions for diarrhoea in 6 - 60-monthold children admitted to Morogoro Regional Hospital, Tanzania. South African Journal of child Health.2012; 6(3):81-84.
12. JA Begum Impact of electrolyte disturbances in outcome of acute diarrhea in children. DS (Child) H J 2010; 26 (1): 36-40
13. Wathen JE, Mackenzie T and BothnerJP. Usefulness of the serum electrolyte panel in the management of pediatric dehydration treated with intravenously administered fluids. Paediatrics 2004; 114: 1227-34
14. Subba Gangaraj, Ghanshyam Das, Sharma Madhulata3 International Journal of Pharmaceutical Science Invention. 2013; 2 (5):33-36.
15. K. R. Purohit, Electrolyte disturbances in acute diarrhea. The Indian Journal of Pediatrics.1971; 38(10):393-395.