Low Sodium and Albumin Level: Its Association

with Outcome of Severe Acute Malnutrition (SAM)

Management at RSUP dr. Mohammad Hoesin
Palembang
Ika Dian Puspitanza, Moretta Damayanti, Julius Anzar

Department of Child Health, Faculty of Medicine Universitas Sriwijaya,

Mohammad Hoesin General Hospital, Palembang
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 Background

Successful management of severe acute malnutrition (SAM) may be influenced

by many factors, including abnormal laboratory findings in the early phase of
hospitalization. Previous studies showed that exceptional laboratory results, such
as anaemia, leukopenia, electrolytes imbalance and acidosis, in association with
SAM outcomes, varied.

Refference:
Kluniari NP, Sidiartha IG. Anemia and metabolic acidosis are a predictor for mortality in children
with severe acute malnutrition at Sanglah General Hospital, Bali. Intisari Sains Medis.
2020;11(2):620-4.

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 Objective

To analyse the association between laboratory profiles at the

beginning of hospitalization and outcome of SAM management
at RSUP dr. Mohammad Hoesin Palembang (RSMH).

Methods

 It was a cross-sectional study reviewing medical records of SAM

patients hospitalized between July 2020 until June 2021. The
outcomes were mortality rate and mean weight gain during treatment
categorized as insufficient (<5 g/kg/day) and sufficient (5 g/kg/day).

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 Results

• 146 subjects. Male 79 (54.1%) and female 67 (45.9%).

• Median age 33 (1-215) months.
• Median length of stay 13 (1-42) days.
• Median weight gain was 3.59 (-12.6-31.75) g/kg/day and showed
no relationship with any laboratory profiles.

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 Haematology profiles in SAM patient

Hypoalbuminemia 17.8%
Haematology

Elevated CRP 38.4%

profiles

Thrombocytosis 21.9%

Thrombocytopenia 21.9%

Leukocytosis 44.5%

Leukopenia 12.3%

Anaemia 44.5%

0 10 20 30 40 50

Percentage of cases
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 Electrolyte profiles in SAM patients

Hypophosphatemia 6.2%
Electrolytes

Hypomagnesemia 1.4%
profiles

Hypokalemia 15.1%

Hyponatremia 23.3%

0 5 10 15 20 25

Percentage of cases
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 Analysis of Haematology Profiles in Association
with Mortality

No Factors Died Survive p OR (95%CI)

1. Anaemia (Yes) 8 (12.3%) 57 (87.7%) 0.32* 0.47 (0.15-1.51)
Anaemia (Not) 5 (6.2%) 76 (93.8%)    
2. Leukopenia (Yes) 1 (5.6%) 17 (94.4%) 1.00** 1.76 (0.21-14.93)
Leukopenia (Not) 12 (9.4%) 116 (90.6%)    
3. Leukocytosis (Yes) 6 (9.2%) 59 (90.8%) 1.00* 0.93 (0.29-2.92)
Leukocytosis (Not) 7 (8.6%) 74 (91.4%)    
4. Thrombocytopenia (Yes) 2 (6.3%) 30 (93.8%) 0.73** 1.60 (0.34-7.63)
Thrombocytopenia (Not) 11 (9.6%) 103 (90.4%)    
5. Trombocytosis (Yes) 2 (6.3%) 30 (93.8%) 0.73** 1.60 (0.34-7.63)
Thrombocytosis (Not) 11 (9.6%) 103 (90.4%)    
6. Elevated CRP (Yes) 5 (8.9%) 51 (91.1%) 1.00** 0.99 (0.31-3.21)
Elevated CRP (Not) 8 (8.9%) 82 (91.1%)    
7. Hypoalbuminemia (Yes) 6 (2.3%) 20 (76.9%) 0.01** 0.21 (0.06-0.67)
Hypoalbuminemia (Not) 7 (5.8%) 113 (94.2%)    
* Pearson Chi-Square
** Fisher's Exact Test 7
 Analysis of Electrolyte Profiles in Association
with Mortality

No. Factors Died Survive p OR (95%CI)

1. Hyponatremia (Yes) 7 (20.6%) 27 (79.4%) 0.01** 0.22 (0.07-0.70)
Hyponatremia (Not) 6 (5.4%) 106 (94.6%)    
2. Hypokalemia (Yes) 3 (13.6%) 19 (86.4%) 0.42** 1.80 (0.45-7.14)
Hypokalemia (Not) 10 (8.1%) 114 (91.9%)    
3. Hypomagnesemia (Yes) 1 (50%) 1 (50%) 0.17** 11.0 (0.65-187.17)
Hypomagnesemia (Not) 12 (8.3%) 132 (91.7%)    
4. Hypophospatemia (Yes) 1 (11.1%) 8 (88.9%) 0.58** 1.30 (0.15-11.31)
Hypophosphatemia (Not) 12 (8.8%) 125 (91.2%)    

* Pearson Chi-Square
** Fisher's Exact Test

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Results of logistic regression analysis of
factors predicting mortality

Factors B p aOR(95%CI)

Hypoalbuminemia 1.31 0.03 3.70 (1.07-12.78)

Hyponatremia 1.27 0.04 3.58 (1.06-12.07)
Constant -3.16    

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 Conclusions

Haematology and electrolytes abnormalities are common in SAM patients,

as in this study where hyponatremia and hypoalbuminemia are significant
factors for the mortality.

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THANK YOU
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