الفهرس 
Acknowledgment
Bacterial infectionsOnly 14 pages are availabe for public view
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Abstract
Diarrheal disease is the second leading cause of deaths in children under five years old, and is responsible for killing around 525 000 children every year. Diarrhea can last several days, and can leave the body without the water and salts that are necessary for survival. In the past, for most people, severe dehydration and fluid loss were the main causes of diarrhea deaths. Now, other causes such as septic bacterial infections are likely to account for an increasing proportion of all diarrhea-associated deaths. Children who are malnourished or have impaired immunity as well as people living with HIV are most at risk of life-threatening diarrhea.
Interventions to prevent diarrhea, including safe drinking-water, use of improved sanitation and hand washing with soap can reduce disease risk. Diarrhea should be treated with ORS, a solution of clean water, sugar and salt. In addition, a 10-14 day supplemental treatment course of dispersible 20 mg zinc tablets shortens diarrhea duration and improves outcomes.
The major complications from diarrhea from any cause are dehydration, electrolyte disturbances and acid-base imbalance. Hypokalimia is one of these complications.
Hypokalemia is a low level of potassium (K+) in the blood serum . Mild hypokalemia does not typically cause symptoms. Symptoms may include feeling tired, leg cramps, weakness, constipation and increase the risk of an abnormal heart rhythm, which is often too slow and can cause cardiac arrest. Treatment of hypokalemia should be directed at the etiology as well as its correction, as treatment of hypokalemia carries with it a significant risk of iatrogenic hyperkalemia.
The aim of this clinical prospective audit study is to assess how much the adopted protocol of management of hypokalemia is practically implemented in gastroenterology unit of AUCH on children with acute gastroenteritis complicated by hypokalemia during the period from the 1st of January 2018 to the 30th of June 2018.
The study included 140 patients presented with acute gastroenteritis and complicated by hypokalemia. Seventy four patients were male and 66 patients were female. One hundred and three patients were below the age of one year old, 34 patients were between 1-2 years old and 3 patients were more than 2 years old.
Data of our study showed that, the gastroenterology unit at AUCH partially followed the reference standard of the study.
1- Data about the name, age, sex and residence were recorded in 100% of patients.
2- Regarding history taking, data of our study showed that history of diarrhea and vomiting was recorded in 100% of patients, while history of fever was only recorded in 61.4% of patients. History of abdominal distention was recorded in 4.3% of patients only, while history of myalgia, muscle weakness, numbness and urine output was not recorded in 100% of patients. Past history was recorded only in 7.9% of patients while type of feeding was recorded in 14.3% of patients.
3- Regarding the assessment of vital signs, data of our study showed that, they were recorded in most of patients and found that, heart rate, respiratory rate, blood pressure and temperature were abnormal in 7.8 %, 17.8%, 9.3% and 46.4% of patients respectively.
4- Body weight measurement was recorded in 97.9% of patients and it was abnormal in 42.8% of patients asunder-weight.
5- General examination data showed that: mental state was recorded in 40% of patients and it was abnormal in 22.9% of patients in the form of disturbed conscious level, drowsiness and irritability. Pallor was assessed in 40% of patients only and it was positive in 15 % of patients only. Jaundice was assessed and recorded in 40% of patients only and it was positive in 1.4% of patients only. Cyanosis was assessed and recorded in 35.7% of patients only and was positive in 2.1% of patients only. Assessment of dehydration state was done and recorded in 67.1% of patients and our study data in recorded patients showed that: moderate dehydration was present in 21.4% of patients while severe dehydration was present in 45.7% of patients.
6- Data of systemic examination showed that: head and neck examination was done in 46.4% of patients and it was abnormal in 40% of patients in the form of pallor, jaundice, cyanosis and signs of dehydration; sunken eye, dry tongue and mucous membrane and depressed anterior fontanel.
Chest examination was done in 79.2% of patients and was abnormal in 28.6% of patients in the form of respiratory distress, acidotic breathing, wheezes and crepitations.
Cardiac examination was done in 62.8% of patients and was abnormal in only 0.7% of patients in the form of audible murmur.
Neurological examination was done only in 28.6% of patients and it was abnormal in 2.8% of patients.
Abdominal examination was done in 39.3% of patients only and it was abnormal in 12.1% of patients in the form of abdominal distension and decreased or absent intestinal sounds.
7- Regarding laboratory investigations, data of our study showed that serum magnesium level was not done in all patients but serum sodium level was done in all patients and it was abnormal in 43.6% of patients. Serum
calcium level was done in 75.7% of patients and it was abnormal in 9.3% of patients. Serum creatinine level was done in 96.4% of patients and it was abnormal in 6.4% of patients. Serum glucose level was done in 10% of patients and it was abnormal in 5.7% of patients.
CBC was done in 90.7% of the studied patients and showed abnormal WBCs, hemoglobin levels (anemic) and platelet count in 59.3%, 67.9% and 42.1% of patients respectively.
8- Data of imaging studies showed that ECG was done only in one patient who was diagnosed as supra-ventricular tachycardia (SVT). Abdominal ultra-sound was done in 10% of patients, and it was abnormal in 6.4% of them only. Plain X- ray abdomen (erect) was done in3.6% of patients, and it was abnormal in 0.7% of them. Consultation of pediatric surgeon was done in 2.9% of patients.
9- Regarding serum potassium level assessment, data of this study showed that, it was done in 100% of patients and 65.7%of patients had mild hypokalemia, and 29.3% of them had moderate hypokalemia while only 5% of them had sever hypokalemia. Follow up of serum potassium level was done in 34.3% of patients only and 27.9% of them improved.
10- Regarding lines of management of dehydration, data of this study showed that, 38.6% of the studied patients received IV shock therapy, 81.4 % of patients received IV fluid therapy, while 49.3% of them received ORS.
11- Potassium replacement therapy data showed that 85.4% of needed patients received oral potassium therapy (35patients out of 41 patients with moderate hypokalemia) and 100% of needed patients received I.V potassium (7 patients out of 7 patients with severe hypokalemia).
The results of the present study showed that, gastroenterology unit of AUCH partially follow the reference study of the protocol of management of hypokalemia as regard:
1- History of abdominal distention was asked and recorded only in 4.3% of patients.
2- History of myalgia, muscle weakness, numbness and urine output was not asked or recorded in 100% of patients.
3- Serum magnesium level was not done in all patients.
4- ECG was done in one patient only.