A 2-year-old child from a rural area presents with severe acute malnutrition (SAM) with bilateral pitting pedal edema, sparse reddish discoloration of hair, and a miserable affect. Serum albumin is 1.8 g/dL. Which electrolyte disturbance is the MOST DANGEROUS and requires careful correction in this child?
- A Hyponatremia, which should be corrected rapidly with hypertonic saline
- B Hypokalemia, which must be corrected and maintained during refeeding to prevent fatal arrhythmias ✓
- C Hypercalcemia, which predisposes to renal calculi during refeeding
- D Hypochloremia, which must be corrected with saline to prevent metabolic alkalosis
Explanation
In kwashiorkor/SAM, hypokalemia is the most clinically dangerous electrolyte disturbance. Potassium depletion is profound due to intracellular shifts and poor dietary intake. During refeeding, potassium is rapidly taken up intracellularly with carbohydrate metabolism, worsening hypokalemia and causing potentially fatal cardiac arrhythmias. WHO guidelines for SAM management emphasize potassium supplementation (3–4 mmol/kg/day) throughout treatment. Hyponatremia in SAM is often dilutional and should NOT be rapidly corrected with hypertonic saline as it carries risk of central pontine myelinolysis. Hypercalcemia and hypochloremia are not primary concerns.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.