Early electrolyte monitoring is associated with nearly 10% lower overall mortality rate of children in Pediatric Intensive Care Unit (PICU)
Editors:
- Dr. Praful B. Godkar (Ph.D)
Eminent Author, Medical Biochemist and Scientist, Technical Education consultant. AGD Biomedicals (Pvt) LTD. - Dr. Gauri Kulkarni MD (Pathology)
Vice President, AGD Biomedicals (Pvt) LTD.
Electrolyte imbalances in the case of children in Pediatric Intensive Care Unit (PICU) are strongly associated with adverse outcomes(1-3). Electrolyte imbalance is responsible for seizures observed in approximately 20% of sick children(1-3). Quick testing of serum electrolytes is extremely useful for immediate treatment on electrolyte imbalance and for prevention of the neurological events related to seizures. Early recognition of electrolyte imbalances and prompt correction of serum electrolyte values are also necessary to prevent prolonged hospital stays and later on may be the need for invasive support like ionotropes and ventilators(4). Prompt electrolyte monitoring in PICU is associated with nearly 10% lower overall mortality rate(1-3). Electrolytes can be quickly measured using the advanced AGD EL-120 analyzer, built with cutting-edge technology and aligned with NABL diagnostic standards(4).
Q1. What is a seizure?
ANS: A seizure is caused by a temporary sudden change in the normal electrical signal activity of the brain. It causes involuntary movements or behaviors in the patient. Some patients may lose consciousness during a seizure. In the case of a normal individual, electrical activity in the brain involves nerve cells in different areas of the body sending signals at different times. During a seizure, many neurons fire all at once.
Q2. What is the difference between seizures and epilepsy?
ANS(5): Refer Table 1 below:
TABLE 1: Seizure and Epilepsy Difference
| FEATURE | SEIZURE | EPILEPSY |
| Occurrence | A single incident | A pattern of repeated incidents over time |
| Triggers | Often “provoked” by temporary factors like high fever, hypoglycemia, trauma, head injury, drug-related, etc. | Usually “unprovoked”. Occur mainly due to underlying genetic brain abnormalities. |
| Diagnosis | Based on the observation of a clinical event. | Diagnosed after two or more unprovoked seizures in 24 hours. |
| Treatment | By addressing the immediate underlying cause. | Require long-term management using anti-seizure medicines. |
Q3. What are the signs & symptoms of a seizure?
ANS: Patients suffering from seizure have jerking movements in part of their body or the whole body. They may stare into space. After a seizure, the patient may suffer from headache, feel tired and confused.
Q4. What is status epilepticus (SE)?
ANS: Status epilepticus (SE) is a seizure, or series of seizures, that lasts for more than 30 minutes. SE is a life-threatening emergency and needs urgent diagnosis and prompt treatment.
Q5. What are the main reasons for childhood seizures?
ANS: The main reasons for childhood seizures can be of two categories:
(A) Provoked Seizures (Caused due to temporary triggers) and
(B) Unprovoked Seizures (Caused due to underlying clinical conditions).
Q6. What are provoked seizures?
ANS: Provoked seizures may result from high fever, rapid electrolyte shifts due to fluid loss, hypoglycemia, severe infections, trauma, head injury, or concussion.
Q7. What are unprovoked seizures (underlying conditions)?
ANS: Unprovoked seizures may result from various factors, including underlying genetic anomalies affecting the anatomy and physiology of the patient’s brain, complications arising during birth or prematurity, as well as conditions such as cerebral palsy, autism, stroke, or tumor.
NOTE: In about 50%-70% of pediatric epilepsy cases, the exact cause may be idiopathic (unknown)(1-3).
Q8. What are the possible biochemical changes that lead ARDS patients to experience seizures?
ANS: Patients with ARDS may experience seizures primarily when impaired lung function leads to inadequate oxygen and electrolyte delivery to the brain via the bloodstream. The brain is highly dependent on oxygen and electrolytes to carry out specific electrical events that facilitate internal and external communication functions. In ARDS, hypoxia and dyselectrolytemia leads to instability in electrical signals conducted by the brain leading to seizures.
Q9. In patients with ARDS, which electrolyte imbalances trigger seizures?
ANS: Electrolyte imbalances in patients with ARDS can precipitate seizures, as electrolytes such as sodium, potassium, chloride, and calcium are critical for maintaining neuronal electrical signaling and membrane stability. In ARDS-related dyslectrolytemia, brain cell membrane stability disturbance leads to seizures.
CASE STUDY
A nine-month-old male child presented to tertiary care unit with a 2-day history of high fever (1020C), extreme shortness of breath, rapid and labored breathing, chest retractions, lethargy and seizures. There was no previous history of seizures and intake of drugs. His blood oxygen level was 87% (Normal 95-100%). Both his nasopharyngeal throat swab and blood samples were collected. Plasma from heparinized blood was separated immediately, and electrolytes were determined in 2-3 minutes by electrolyte analyzer based on POCT technology.
SERUM ELECTROLYTES
| PARAMETER | RESULT | REFERENCE RANGE |
| Serum sodium | 124 mEq/l | 133–146 mEq/l |
| Serum potassium | 7.3 mEq/l | 3.8–5.6 mEq/l |
| Serum chlorides | 82 mEq/l | 95–106 mEq/l |
INTERPRETATION
Decreased serum sodium and chlorides and increased serum potassium indicate electrolyte imbalance, which is commonly observed in patients suffering from seizures during acute respiratory distress syndrome(1-3).
NOTE:
(A) A 9-month-old infant with seizures and respiratory distress required urgent stabilization and diagnosis. The main goal of treatment was to stop the seizure immediately and prevent brain injury(1-3).
(B) When administering medications, it is necessary to get IV access as soon as possible. Rehydration and electrolytic balance were restored with intravenous fluid therapy according to plasma electrolyte report.
References
(1) Riviello JJ, Ashwal S, Hirtz D, et al. Practice parameter: Diagnostic assessment of the child with status epilepticus (an evidence-based review); Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2006;67(9):1542-50.
(2) Sofou K, Kristjánsdóttir R, Papachatzakis NE, Ahmadzadeh A, Uvebrant P. Management of prolonged seizures and status epilepticus in childhood: A systematic review. J Child Neurol 2009;24(8):918-26.
(3) Gaínza-Lein M, Fernandez IS, Jackson M, et al. Association of time to treatment with short-term outcomes for pediatric patients with refractory convulsive status epilepticus. JAMA Neurol 2018;75(4):410-8.
(4) Godkar PB, Godkar DP. Textbook of Medical laboratory technology (4th edition, 2024), Bhalani Publishers, Mumbai. India.
(5) Godkar PB, Godkar DP. Human anatomy and physiology, Theory and Practicals, Questions and Answers. First Edition (2025).
(6) Bockenkamp B, Vyas H. Understanding and managing acute fluid and electrolyte disturbances. Current Paediatrics. 2003; 13:520–528.
(7) World Health Organizations. Emergency Triage Assessment (ETAT): Manual for participants. Geneva: WHO;2016.
