Praveen Naik¹, V Rajesh Reddy Komatla^2*

^1,2Assistant Professor, Department Of Medicine, Kamineni Institute Of Medical Sciences, Narketpally, Nalgonda(Dist) Telangana, INDIA.

Email: praveendr1986@gmail.com

Collected data was analysed statistically. Statistical analysis was done using descriptive statistics.

RESULTS

During study period, total 138 patients satisfying inclusion and exclusion criteria were considered for present study. 19 – 39 years age group was most common (41 %) followed by 40 – 59 years age group (34 %) and > 60 years age group (25 %). Male patients (54 %) were more than female patients (54 %). Mean age in present study was 41.5 ± 12.4 years.

Table 1: Age and sex distribution of the study population

Serum electrolyte mean values were 137.04 ± 6.31 mEq/L, 3.82 ± 0.66 mEq/L and 106.04 ± 3.24 mEq/L for sodium, potassium and chloride respectively.

Table 2: Laboratory parameters of patients

According to WHO classification we had 45 % patients of dengue fever and 55% patients of dengue haemorrhagic fever. Serum chloride levels were normal in all patients. In present study hyponatremia was noted in 22% patients while hypernatremia was noted in 2% patients. 75% patients had normal serum sodium levels. Mild, moderate and severe hyponatremia was noted in 15 %, 4 % and 3 % patients respectively.

Table 3: Severity of dengue infection and serum sodium levels

Hypokalemia was noted in 26% patients while hyperkalemia was noted in 1% patient. 73% patients had normal serum sodium levels. Mild, moderate and severe hyponatremia was noted in 20 %, 4 % and 2 % patients respectively.

Table 4: Severity of dengue infection and serum potassium levels

DISCUSSION

Dengue viral infection has emerged as one of the most important arboviral disease in India. Dengue fever is a viral exanthematous febrile illness emerged as a major public health problem in India. The World health Organization (WHO) estimated that 50 to 100 million dengue infections occur in the world including 500,000 DHF and 22,000 deaths mostly among children. Assessment of serum electrolytes is routinely done in patients admitted to the hospital with dengue fever (DF) and dengue haemorrhagic fever (DHF). Hyponatraemia is defined as plasma Na+ concentration below 135 mEq/ l and hypokalaemia is defined as K+ concentration below 3.5 mEq/l3.  Electrolyte disturbances and renal dysfunction have been reported in dengue infection. Sodium is an essential nutrient in humans; regulates blood volume, blood pressure, osmotic equilibrium and ph. Hyponatremia is frequent in dengue, which can cause central nervous system dysfunction. In our study, the mean value of serum sodium observed was 137.04 ± 6.31 mEq/L. This is more than in the study done by Mekmullica et al...⁸, which had a mean of 132 mEq/L and Lumpaopong et al...⁹, found that serum sodium level in dengue patients in Thailand was 133meq/L. we noted 22% cases of dengue with hyponatremia. In a study done with dengue fever in a tertiary care centre in Mumbai found the prevalence of hyponatraemia to be 40.3%.¹⁰ A study done in Salem, Tamil Nadu in 2014 among patients with dengue fever showed the prevalence of hyponatraemia to be 58%, but hypokalaemia was not found among the study patients.⁶ In study by Reddy AA et al... noted that, with the decreasing serum sodium levels, there is an increasing incidence of associated complications. Also bleeding and the CNS complications are more common as compared to respiratory, hepatobiliary and other complications.⁷ Hypokalaemia is also common in Dengue which can lead to acute neuromuscular weakness including respiratory muscle paralysis. The possible mechanisms postulated are redistribution of potassium into the cells or transient renal tubular abnormalities leading to increased urinary potassium wasting. Increased catecholamine levels in response to stress of the infection and secondary insulin release can result in intracellular shift of potassium and hypokalemia.¹³ In present study mean serum potassium levels were 3.82 ± 0.66 mEq/L and incidence of hypokalemia was 26%. Khandelwal Vinay et al.., studying electrolyte disturbances in dengue fever in adults where 55.44% patients had normal serum potassium levels, 33.16% patients had mild hypokalemia, 5.94% patients reported moderate hypokalemia and 2.97% patients reported severe hypokalemia while 2.47% patients also reported hyperkalemia in this study. The mean value of serum potassium was 3.62 mEq/L.¹⁴  Coexistent magnesium deficiency complicates hypokalemia and renders it refractory to potassium supplementation. A decrease in intracellular magnesium, resulting from magnesium deficiency releases the magnesium-mediated inhibition of renal outer medullary K+ channels and increases potassium secretion in the distal tubules thus aggravating hypokalemia.¹⁵ A significant increase in the incidence of hyperkalemia than in secondary dengue infection is also noted. The reason for the increase in potassium level in secondary dengue patients could be severe hemolysis leads to the release of intracellular potassium into extracellular space, other causes of increased potassium in dengue patients could be rhabdomyolysis and renal dysfunction, needs further studies to confirm. No specific treatment is available for dengue infection, and the mainstay of treatment is careful fluid management, specific organ support and correction of metabolic and electrolyte derangement. Many studies recommended early screening for electrolyte imbalance to identify the high-risk patients, which in turn could prevent the serious complications associated with dengue virus infection and initiation of appropriate fluid therapy with close monitoring.¹⁷

CONCLUSION

Hyponatemia and hypokalemia are the commonest electrolyte disturbances seen in dengue fever. They may be associated with poor treatment outcomes. Routine screening of dengue patients for electrolytes may help the clinicians in risk stratification of patients. Considering the variations in serum electrolyte levels in patients of dengue and high incidence of dengue in India, it is necessary to have a degree of suspicion in patients of dengue about electrolyte disturbances and treat them accordingly. Careful monitoring of electrolytes, acid-base status, and renal function are mainstay for patient care.

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