Hypokalemia in a pediatric intensive care unit.

OBJECTIVE: To examine the frequency, severity, risk factors and mortality of hypokalemia, and efficacy of therapy used for its correction. DESIGN: Descriptive, retrospective analysis. SAMPLE: 290 patient records admitted consecutively to a Pediatric Intensive Care Unit (PICU) over a period of one year. RESULTS: Forty three (14.8%) patients had 54 episodes of hypokalemia. Predisposing factors included the nature of primary disease (renal disease 19%, septicemia 19%, acute diarrhea 14%, heart disease with congestive failure, and meningoencephalitis 12% each), malnutrition (weight for age less than 80% in 72%) and therapy with drugs (diuretics, corticosteroids and antiasthma drugs). For correction of hpokalemia all the patients received 4-6 mEq potassium per 100 ml of intravenous fluids (slow correction). Seven patients (9 episodes), with ECG changes of hpokalemia, also received infusion of 0.3 mEq potassium/kg/hour till ECG became normal (rapid correction). Normal potassium level was achieved in all nine episodes where rapid correction was given, and in 40 of 45 episodes which received slow correction. The overall mortality among patients with hypokalemia (25.6%, 11/43) was significantly higher than that among the remaining PICU patients (10.9%, 27/247; odd's ratio 2.34; 95% confidence interval 1.3-4.2) (p < 0.05). All the patients receiving rapid correction survived. CONCLUSIONS: Hypokalemia is a common problem among PICU patients. Early detection through regular monitoring and rapid correction may help in improving the outcome.