Evaluation of water and electrolytes disorders in severe acute diarrhea patients treated by WHO protocol in eight large hospitals in Tehran; a nephrology viewpoint

Introduction: The most common cause of death from diarrhea is the shock caused by dehydration, electrolytes and acid-base disorders. Objectives: The aim of this study was to evaluate water and electrolytes disorders in diarrhea patients after treating severe acute diarrhea. Patients and Methods: In this study we used a historical cohort and studied patients who were hospitalized due to acute diarrhea and were similarly treated for dehydration and water and electrolyte disorders as recommended by the World Health Organization (WHO) guideline. Electrolytes, pH, serum creatinine (Cr) level on admission and during treatment were recorded. Patients with underlying diseases were excluded from the study. Results: Of 121 patients who were enrolled in the study, 67.8% had hyponatremia on admission (plasma Na <137 mEq/L) and 5.8% had hypernatremia. Around, 33.88% of patients had hypokalemia and 2.4% had hyperkalemia. All hyperkalemia disorders were treated, but 87.1% of patients had hypokalemia or low potassium levels, or they were affected by uncorrected hypokalemia and were in need of further measures. Of all, 56.75% had acidosis and 21% of patients with acidosis were not treated or the severity of their acidosis increased during treatment. There was a significant relationship between acute renal failure (ARF) and hypokalemia at the time of admission (P<0.001), potassium loss during treatment (P<0.001), acidosis (0.005), and cholera-related diarrhea (0.05). Conclusion: The high prevalence of hypokalemia in these patients as well as potassium loss during treatment indicates insufficient level of potassium in the therapeutic solutions. Mild hyponatremia in most patients highlights the need for isotonic solutions to treat dehydration.