Definition

Electrolyte imbalances in children are a group of conditions caused by temporary disturbances in the levels of electrolytes in the body, where the levels become too high or too low. Changes in electrolyte levels can indicate an underlying health problem.

Electrolytes are electrically charged minerals found in body fluids such as blood. Examples of electrolytes include sodium, potassium, chloride, calcium, magnesium, phosphate, and bicarbonate.

Electrolytes play a role in:

• Balancing water levels and maintaining acid-base (pH) balance in the body.
• Sending nerve signals between cells.
• Muscle contraction and relaxation.
• Maintaining brain and heart function, among other roles.

Electrolytes are obtained from the food and beverages consumed. The kidneys help maintain electrolyte balance by filtering electrolytes, water, and other nutrients from the blood, which are then reabsorbed by the body. Maintaining normal electrolyte levels is crucial for the health of nerves, muscles, and other organs like the brain, heart, lungs, and kidneys.

Causes

Electrolyte imbalances in children most commonly occur due to:

• Vomiting
• Diarrhea
• Insufficient food or water intake
• Fever
• Excessive sweating
• Certain medications

Electrolyte imbalances can occur when a child is dehydrated (lacks fluids) or has excess fluids in the body. Dehydration happens when the body loses too much fluid and cannot replace it quickly enough to meet the body's needs.

Children are particularly vulnerable to dehydration because of their small body size and high metabolic rate, which causes them to replace fluids and electrolytes more rapidly than adults.

Below are some conditions of electrolyte deficiency or excess.

Calcium

Children with chronic kidney disease, nutritional disorders, or thyroid abnormalities like Graves' disease can have high calcium levels. High or low calcium levels can lead to issues such as kidney stones or heart rhythm disturbances.

Potassium

Children can experience potassium deficiency in the following conditions:

• Vomiting or diarrhea leading to the loss of electrolytes.
• Use of medications such as diuretics (to help eliminate fluid) or laxatives (to ease bowel movements).
• Diabetic ketoacidosis, where the body accumulates ketones (by-products of fat breakdown). This condition can occur in children with diabetes.

High potassium levels may be seen in children with:

• Poor kidney function, where minerals cannot be excreted through urine.
• Adrenal gland disorders above the kidneys, which play a role in blood pressure and metabolism regulation.

Sodium

Sodium helps maintain fluid balance in the body. Sodium imbalance is typically caused by:

• Dehydration
• Excessive sweating
• Severe burns
• Kidney disease

Risk Factor

Children are susceptible to dehydration, and any medical condition that can cause dehydration, such as severe vomiting, diarrhea, and high fever, increases the risk of fluid and electrolyte imbalances.

Electrolyte imbalances are also commonly found in children with serious medical conditions.

• Chronic kidney disease reduces the kidneys' ability to maintain normal fluid and electrolyte levels.
• Heart disease can disrupt the body's regulation of sodium and water.
• Hormonal disorders from the thyroid or parathyroid glands in the neck.
• Systemic infections in the bloodstream.
• Side effects of certain medications.
• An unbalanced diet lacking or excessing in electrolytes.

Symptoms

Symptoms of electrolyte imbalance vary depending on which electrolyte is out of balance. Mild imbalances often show no symptoms and become noticeable only in severe cases. The severity of symptoms is also influenced by other existing medical conditions in the child.

Electrolyte imbalances can cause symptoms such as:

• Fluid deficiency
• Dark-colored urine
• Weakness
• Muscle cramps or spasms
• Dizziness
• Headache
• Constipation or diarrhea
• Nausea and vomiting
• Breathing difficulties
• Rapid heartbeat

Severe electrolyte imbalances can cause symptoms such as:

• Seizures
• Reduced consciousness or coma
• Metabolic acidosis, a condition where acid builds up in body fluids
• Rhabdomyolysis, a condition where muscle tissue breaks down and releases damaged proteins into the blood

Diagnosis

The doctor will interview the parents about the child's symptoms and how long they have been present. The child's medical history and treatments will also be discussed. A physical examination and laboratory tests will be conducted to diagnose fluid and electrolyte imbalances in the child.

Physical Examination

During the physical examination, the doctor will assess the severity of the imbalance and identify possible causes. Vital signs such as blood pressure, pulse, breathing rate, and temperature will be checked. Dehydration signs will be examined through the appearance of the eyes, skin turgor, the child's level of alertness, and their ability to drink fluids.

A head-to-toe examination will be performed, especially if the child has a history of hormonal disorders, kidney disease, or heart disease.

Laboratoium Tests

Blood and urine tests are used to confirm electrolyte imbalances and assess their severity. Normal electrolyte levels in children are:

• Sodium: 136 - 145 mEq/liter
• Potassium: 3.5 - 5.0 mEq/liter
• Calcium: 8.8 - 11.2 mg/dL
• Magnesium: 1.5 - 2.5 mEq/liter
• Phosphorus: 3.6 - 5.6 mg/dL

Based on these test results and existing medical conditions, the doctor will develop a treatment plan to correct fluid and electrolyte imbalances and prevent complications.

Management

If a child suddenly experiences vomiting, diarrhea, or fever accompanied by heavy sweating, consuming water or oral rehydration solutions like ORS can help restore electrolyte balance. Many rehydration solutions are available over the counter and can be helpful in mild cases as first aid.

For moderate to severe electrolyte and fluid imbalances, or if the child cannot drink due to reduced consciousness or severe illness, intravenous fluid therapy will be administered. Fluids will be given through a vein to restore the child's condition. This therapy will be monitored by a doctor to prevent complications.

If the child has other medical conditions accompanying the electrolyte imbalance, treatment will be comprehensive and tailored to the child's condition.

Complications

Children are at increased risk of serious complications from fluid deficiency. Severe dehydration and accompanying electrolyte imbalances can disrupt blood flow and mineral supply to vital organs like the brain, heart, and liver. In rare cases, this can cause swelling or shrinkage of brain tissue, seizures, metabolic disturbances, or life-threatening heart rhythm disorders.

Prevention

To prevent electrolyte imbalances, ensure children drink enough water and eat a healthy, balanced diet that meets all their nutritional needs. Avoid excessive physical activity, especially during the heat of the day, to prevent dehydration.

When to See a Doctor?

Seek immediate medical attention if your child shows signs of not wanting to eat or drink, vomiting, diarrhea, or fever, especially if these symptoms have been present for several days. This is particularly important for children with pre-existing medical conditions. Quick diagnosis and treatment are crucial to prevent worsening conditions.

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