Severe hypophosphatemia, serum phosphate concentration <0.32 mmol/L (<1.0 mg/dL), occurred in 8 of 68 (12%) of children with kwashiorkor within 48 hours of admission; 5 of 8 (63%) of these children died, compared with 13 of 60 (22%) children without severe hypophosphatemia (P <.02). Dermatosis and dehydration were significantly correlated with severe hypophosphatemia, but these clinical signs could not reliably predict fatal cases. Severe hypophosphatemia seems to be common and life-threatening in children with kwashiorkor in Malawi.
PIP: Severe hypophosphatemia, serum inorganic phosphate concentration of less than 0.32 mmol/l, is associated with leukocyte dysfunction, acute respiratory decompensation, cardiac arrhythmias, and heart failure. The condition has been described in children with kwashiorkor from South Africa, but not in children from Jamaica or India. In acute kwashiorkor in sub-Saharan Africa, the case fatality rate remains high, often over 20%, despite the implementation of standard treatment protocols. The authors examined whether severe hypophosphatemia was frequent at presentation or during initial refeeding among Malawian children with kwashiorkor and whether it was associated with a fatal outcome. All children under age 10 years who presented with kwashiorkor to the Queen Elizabeth Central Hospital in Blantyre during a 2-month period were eligible and enrolled in the study. 68 children with kwashiorkor were studied. Severe hypophosphatemia occurred in 8 (12%) children with kwashiorkor within 48 hours of admission. 5 of these 8 (63%) children died, compared with 13 of 60 (22%) children without severe hypophosphatemia. Dermatosis and dehydration were significantly correlated with severe hypophosphatemia, but these clinical signs could not reliably predict fatal cases. Severe hypophosphatemia appears to be common and life-threatening in children with kwashiorkor in Malawi.