Study of Serum Electrolytes and Calcium Changes in Children with Severe Pneumonia and it’s Outcome


Deepa Dinesh Joshi
Sanjita Ram Chaddha
Suhas Patil
Nilesh Vitthalrao Ahire


Background: Electrolyte imbalance is one of the serious complications in hospitalized children with severe pneumonia. Monitoring of changes in electrolytes is very essential to prevent the complications leading to increased morbidity and mortality. Aims and objectives: To study serum electrolytes and calcium disturbances in patients with severe pneumonia. To identify relation of serum electrolytes with outcome of severe pneumonia. Material and Methods: After taking approval of ethics committee of our institute, we studied a total of hundred cases over a span of 24 months- August 2018 to December 2020. Study is carried out among cases of severe pneumonia and community acquired pneumonia (CAP) in age group of 2 months to 5 years admitted in pediatrics department of tertiary care centre in Maharashtra. Laboratory investigations of serum sodium, potassium, chloride and calcium levels were noted at admission and 24 hours after hospitalization. Results: This is observational cross study carried out in 100 children of severe pneumonia admitted in paediatric intensive care unit at Dr. Vasantrao Pawar Medical College, Nashik to observe and study electrolyte changes in them. Most children were in age group of 2 months to 12 months (i.e., 72%) followed by 28% in age group of 13 months to 60 months. At admission most common abnormality was hypocalcemia 49% followed by hyponatremia 27%, hyperchloremia 7%, hyperkalemia 6%, hypernatremia 6%, hypokalemia 4%, hypochloremia 1%. After 24 hours of stabilization hyponatremia was most common 40%, followed by hapocalcemia 43%, hypokalemia 9%, hypernatremia 8%, hyperkalemia 4%, hyperchloremia 4%. Conclusion: Mortality was significantly higher in cases with chloride level abnormality than with normal chloride level. Cases with disturbances in electrolytes showed higher mortality than those without electrolyte disturbances. Hyponatremia and hypokalaemia were associated with adverse outcomes in pneumonia cases. Electrolyte disturbances are commonly seen in pneumonia cases, so we should monitor them properly while treating them to avoid complications. Hyponatremia in pneumonia occurs due to Syndrome of Inappropriate Anti Diuretic Hormone secretion (SIADH). Hyponatremia at admission significantly affect outcome in terms of prolonged duration of hospitalization and two fold increase in mortality.


How to Cite
Joshi, D. D. ., Chaddha, S. R. ., Patil, S. ., & Ahire, N. V. . (2022). Study of Serum Electrolytes and Calcium Changes in Children with Severe Pneumonia and it’s Outcome. MVP Journal of Medical Sciences, 267–273.


  1. World Health Organization. 2017. Fact sheet-Pneumonia. Available from:
  2. UNICEF. 2017. Factsheet- Pneumonia. Available from:
  3. World Health Organization. 2009. Fact sheet number 331 - Pneumonia. Available from:
  4. Mani CS and Murray DL. Acute pneumonia and its complications. In Elsevier principles and practice of paediatric infectious diseases; 2020. p. 235-45. PMid:22567708 PMCid:PMC7152347
  5. Ortqvist A,Hedlund J, Grillner L, Jalonen E,Kallings I, Leinonen M, Kalin M. Aetiology, outcome and prognostic factors in community-acquired pneumonia requiring hospitalization. Eur Respir J. 1990 Nov; 3 (10) :1105-13.
  6. Gothankar J, Doke P, Dhumale G, Pore P, Sanja S, Quraishi S, et al. Reported incidence and risk factors of childhood pneumonia in India: A community-based cross-sectional study. BMC Public Health. 2018; 18:1111 PMid:30200933 PMCid: PMC6131850
  7. Singhi S, Dhawan A. Frequency and significance of electrolyte abnormalities in pneumonia. Indian Pediatr. 1992 Jun; 29 (6) :735-40. PMID:1500133.
  8. Sundarman AW, Austin JW, Camac JG. Studies in serum electrolytes concentration of electrolytes and nonelectrolytes in serum during lobar pneumonia. J Clin Invest. 1926; 3:37-64. PMid:16693708 PMCid:PMC434614
  9. Sunderman FW. Studies of serum electrolytes: V. Chloride and nitrogen balances and weight changes in pneumonia. J Clin Invest. 1929; 7:313-332. PMid:16693863 PMCid:PMC424583
  10. Sunderman FW. Studies of Serum electrolytes: VII. Total base and protein components of serum during lobar pneumonia with note on gastric secretions. J Clin Invest. 1931; 615-627. PMid:16693954 PMCid:PMC435719
  11. Gram HC. Observations on regulation of osmotic pressure (conductivity, chloride freezing point and proteins of serum). J Biol Chem. 1923; 16:593-599.
  12. Moreno-PO, Leon-Ramirez JM, Fuertes-Kenneally L, Perdiguero M, Andres M, Garcia-Navarro M, RuizTorregrosa P, Boix V, Gil J, Merino E. COVID19- ALC Research Group. Hypokalemia as a sensitive biomarker of disease severity and the requirement for invasive mechanical ventilation requirement in COVID-19 pneumonia: A case series of 306 Mediterranean patients. Int J Infect Dis. 2020 Nov; 100:449-454. PMid:32950739 PMCid:PMC7497734
  13. Brem AS. Disorders of potassium homeostasis. Paediatric Clin North Amir. 1990, 37:419-428.
  14. Rahman F, Siddique MAB, Hassan MW, Bari MN, Ahmeed F. A study on electrolyte imbalance in asphyxiated neonates. KYAMC Journal. 2017; 7 (2) :775-79.
  15. Sankaran RT, Mattana J, Pollack S, Bhat P, Ahuja T, Patel A, Singhal PC. Laboratory abnormalities in patients with bacterial pneumonia. Chest. 1997 Mar; 111 (3) :595-600. PMid:9118693
  16. Praneetha CK, Ahirrao VS, Srinivasa K, Premalatha R, Ravichander B. Hyponatremia in children of 2 months to 5 years of age with community acquired pneumonia and its correlation with severity of illness and outcome. Pediatric Review: International Journal of Pediatric Research. 2019; 6(11) :56.