SELECTED ADMISSION SERUM ELECTROLYTE LEVELS AND ASSOCIATED CLINICAL OUTCOMES IN CRITICALLY ILL PATIENTS ADMITTED TO THE KORLE-BU TEACHING HOSPITAL, ACCRA

Abstract

INTRODUCTION Electrolytes are minerals that carry an electric charge when dissolved in body fluids (serum) such as blood. Disturbances in serum electrolyte levels are associated with multiple organ system dysfunction; cardiac, respiratory, neuromuscular, immunologic and haematologic function. It is therefore important for clinicians to understand the electrolyte pathophysiology in critical illness. This study therefore seeks to determine some selected serum electrolyte (Phosphate, Magnesium, Calcium, Sodium, Potassium and Chloride) levels and their effect on critically ill patients. AIM To determine the admission levels of selected serum electrolytes (Phosphate, Magnesium, Calcium, Sodium, Potassium and Chloride) and their association with clinical outcomes in critically ill patients at the Korle-Bu Teaching Hospital (KBTH), Accra. METHODOLOGY This was a longitudinal study involving 26 critically ill patients admitted to the Surgical Ground Floor Intensive Care Unit (ICU) and High Dependency Units (HDUs) of KBTH. Laboratory determination of serum electrolytes (Phosphate, Magnesium, Calcium, Sodium, Potassium and Chloride) of the critically ill patients was done at admission and their SOFA scores calculated. Clinical outcomes such as Length of ICU stay (LOS), duration of mechanical ventilation, duration of inotropic support and mortality were measured upon follow up of the patients. The relationship between the measured electrolytes and their association with clinical outcomes was determined using the Pearson correlation co-efficient. Fisher’s Exact test was used to determine the effect of the measured serum electrolytes on mortality. RESULTS The mean admission serum electrolyte levels were: Phosphate (1.35(± 0.84) mmol/l), Magnesium (0.83 (± 0.25) mmol/L), Calcium (1.12 (±0.12) mmol/l), Sodium (139 (± 5.3) mmol/L), Potassium (4.32 (±1.06) mmol/L) and Chloride (104 (±6) mmol/L). There was a positive significant association between serum phosphate and serum magnesium (p-value=0.011) and a non-significant positive association with serum calcium levels (p-value=0.748). There was however a non-significant negative association between serum calcium and serum magnesium levels at admission (p-value=0.175). There was a significant positive correlation between serum phosphate and SOFA scores (p-value=0.041) and mortality (p-value=0.110). A non-significant negative correlation was found between serum phosphate and duration of ventilatory support (p-value=0.638), inotropic support (p-value=0.718) and LOS (p-value=0.683). There was a non-significant positive correlation between serum magnesium and SOFA scores (p-value=0.912) and mortality (p-value=0.199). A non-significant negative correlation was noted between serum magnesium levels and duration of inotropic support (p-value=0.655) and LOS (p-value=0.772). There was a non-significant positive correlation between serum calcium levels and SOFA scores (p-value=0.912), LOS (p-value=0.439), and duration of inotropic support (p-value=0.333). A non-significant negative correlation was found between serum calcium levels and mortality (p-value=0.240). Hypernatraemia and hypophosphataemia were associated with high mortality, though not statistically significant. CONCLUSION Derangements in admission serum electrolyte levels had an effect on SOFA scores, LOS, duration of inotropic support, duration of ventilatory support and mortality in critically ill patients. Hypernatraemia and hypophosphataemia were associated with hundred percent mortality.