Study of sodium and potassium ion disturbances in malaria at Ahmedabad, Gujarat, India

Study of sodium and potassium ion disturbances in malaria

International Archives of Integrated Medicine, Vol.

Copy right © 2014, IAIM, All Rights Reserved.

Original Research Article


at Ahmedabad, Gujarat, India

1 Assistant Professor, Medicine Department

Abstract

Background: Malaria is an endemic di

mosquito. Electrolyte disturbances particularly hyponatremia is a common complication in malaria.

Aim: To determine sodium and potassium ion disturbances in malaria cases at Ahmedabad, Gujarat.

Material and methods: Total 200 indoor and outdoor patients of malaria

hospital, Ahmedabad during period of

Patients were diagnosed for malaria after the examination of bo

smears and malarial antigen detection rapid card test.

laboratory investigations like complete blood count and serum electrolyte (sodium and potassium

ion).

Observation: Hyponatremia and hypokalemia were more common in both P. Falciparum and P.

Vivax malaria. Severity of hyponatremia and hypokalemia were more in P. Falciparum than P. Vivax

Conclusion: Serum electrolytes must be estimated in each malaria case to prevent grave

complications.

Key words

Malaria, Hyponatremia, Hypokalemia, P. Falciparum, P. Vivax.

Introduction

Malaria is parasitic infection and

disease in Gujarat, caused by the bite of the

female anopheles mosquito.

world’s population is vulnerable to malaria and

Received on: 11-08-2014

Revised on: 21-08-2014

Accepted on: 31-08-2014

How to cite this article:

disturbances in malaria at Ahmedabad, Gujarat, India. IAIM, 2014; 1(1):

7-11.

Available online a

*Corresponding Author: Sangita Rathod,

AMC MET Medical College, Ahmedabad, India.

E mail: [email protected]


International Archives of Integrated Medicine, Vol. 1, Issue. 1, September, 2014.



at Ahmedabad, Gujarat, India

Sangita Rathod1*

Assistant Professor, Medicine Department, AMC MET Medical College, Ahmedabad, Gujarat, India

an endemic disease in Gujarat, caused by the bite of the

Electrolyte disturbances particularly hyponatremia is a common complication in malaria.

o determine sodium and potassium ion disturbances in malaria cases at Ahmedabad, Gujarat.

Total 200 indoor and outdoor patients of malaria who came to tertiary care

hospital, Ahmedabad during period of July – 2013 to June – 2014 were included in present study.

Patients were diagnosed for malaria after the examination of both thick and thin film peripheral

smears and malarial antigen detection rapid card test. All patients were subjected to relevant


and hypokalemia were more common in both P. Falciparum and P.

Vivax malaria. Severity of hyponatremia and hypokalemia were more in P. Falciparum than P. Vivax

Serum electrolytes must be estimated in each malaria case to prevent grave

Malaria, Hyponatremia, Hypokalemia, P. Falciparum, P. Vivax.

and it is an endemic

caused by the bite of the

Almost half of

world’s population is vulnerable to malaria and

its life threatening complications [1

Approximately 300-500 m

morbidity and 2-3 million cases of mortality

were reported annually due to malaria [1

species of Plasmodium like P. Falciparum, P.

Vivax, P. Malariae and P. O

cause malaria in humans. Out of these four, P.

Falciparum is more responsible for morta

severe complications [2], which include cerebral

malaria, anaemia and renal failure [3

How to cite this article: Rathod S. Study of sodium and potassium ion


11.

Available online at www.iaimjournal.com

Sangita Rathod,

AMC MET Medical College, Ahmedabad, India.

[email protected]


Page 7


, AMC MET Medical College, Ahmedabad, Gujarat, India

caused by the bite of the female anopheles

Electrolyte disturbances particularly hyponatremia is a common complication in malaria.

o determine sodium and potassium ion disturbances in malaria cases at Ahmedabad, Gujarat.

who came to tertiary care

were included in present study.

th thick and thin film peripheral

All patients were subjected to relevant


and hypokalemia were more common in both P. Falciparum and P.

Vivax malaria. Severity of hyponatremia and hypokalemia were more in P. Falciparum than P. Vivax.

Serum electrolytes must be estimated in each malaria case to prevent grave

fe threatening complications [1].

500 million cases of

3 million cases of mortality

ted annually due to malaria [1]. Four

species of Plasmodium like P. Falciparum, P.

Vivax, P. Malariae and P. Ovale are known to

cause malaria in humans. Out of these four, P.

is more responsible for mortality and

], which include cerebral

ia, anaemia and renal failure [3].

S. Study of sodium and potassium ion





P. Falciparum and P. Vivax species

prevalent in India [4]. Sodium ion plays a key

role in the maintenance of the normal

distribution of water and osmotic pressure in

various fluid compartments [5] whereas

potassium ion is a major intracellular cation [6

Electrolyte disturbances par

hyponatremia is a common complication in

malaria. Increased secretion of vasopressin plays

an important role in development

hyponatremia in malaria [7].

study was to determine sodium and potassium

ion disturbances in malaria cases at Ahmedabad,

Gujarat.

Material and method

The present study was conducted at tertiary

care hospital of Ahmedabad, Gujarat between

period of July – 2013 to June –

indoor and outdoor patients of malaria were

included in the study after obtaining their

informed written consent.

diagnosed for malaria after the examination of

both thick and thin film peripheral smears and

malarial antigen detection rapid card test.

Demographic profile and complete history with

vitals for each patient were noted. All patients

were subjected to relevant laboratory

investigations like complete blood count and

serum electrolyte (sodium and potassium i

Complete blood count was done by automated

hematology analyser and serum electrolytes

were measured by fully automated electrolyte

analyser. Hyponatremia is defined as

plasma sodium concentration to <135 m.mol/l

[8]. Hypokalemia is defined as decrease in the

plasma potassium level to <3.5 m.mol/l.

were analysed and presented as mean

standard deviation.

Observation




alciparum and P. Vivax species are more

Sodium ion plays a key

role in the maintenance of the normal

distribution of water and osmotic pressure in

compartments [5] whereas

is a major intracellular cation [6].

Electrolyte disturbances particularly

hyponatremia is a common complication in

malaria. Increased secretion of vasopressin plays

an important role in development of

Aim of present

study was to determine sodium and potassium

es at Ahmedabad,

The present study was conducted at tertiary

care hospital of Ahmedabad, Gujarat between

– 2014. Total 200

indoor and outdoor patients of malaria were

included in the study after obtaining their

informed written consent. Patients were

diagnosed for malaria after the examination of

both thick and thin film peripheral smears and

l antigen detection rapid card test.

Demographic profile and complete history with

vitals for each patient were noted. All patients

were subjected to relevant laboratory

investigations like complete blood count and

serum electrolyte (sodium and potassium ion).

Complete blood count was done by automated

hematology analyser and serum electrolytes

were measured by fully automated electrolyte

emia is defined as decrease in

concentration to <135 m.mol/l

as decrease in the

plasma potassium level to <3.5 m.mol/l. Data

were analysed and presented as mean +

Out of 200 patients of malaria, 94 were male

and 106 were female. Among male patients,

prevalence of P. Falciparum and

was 50% each. Among female patients, 58 were

diagnosed for P. Falciparum malaria and 48 were

diagnosed for P. Vivax malaria. Prevalence of P.

Falciparum malaria was high in age group of 31

40 years in both male and female. Prevalence of

P. Vivax malaria was high in age group of 31

years in male and 21-30 years in female as per

Table – 1. Hyponatremia and hypokalemia were

more common in both P. Falciparum and P.

Vivax malaria. Severity of hyponatremia and

hypokalemia were more in P. Falci

Vivax as per Table – 2 and Table

Discussion

One of the major causes

morbidity in India is malaria. Approximately 300

500 million cases of malaria are noted every

year and more than 1 million die each year [9

P.Falciparum species of malaria is usually

associated with the severe and complicated

forms [10].

Mild hyponatremia in the acute stages of

malaria did not usually affect the mortality and

the morbidity as per Fryatt RJ, et al. [11]. Mild

hyponatremia in the malaria patients

noted by Kakkilaya [12]. There was a gradual

decrease in the sodium and potassium ion levels

within 12 hours of the parasite’s o

per Dworak et al. [13]. Ebele J Ikekpeazu, et al.

[14] also reported reduction in the

potassium ion level in malaria. Cells lost up to

75-80 % of their potassium content during the

course of the malaria attack

al. [15].

Chairul Yoel, et al. [16] reported that the

concentrations of sodium and potassium were

within normal range in malaria.

about changes in levels of e


Page 8

Out of 200 patients of malaria, 94 were male

and 106 were female. Among male patients,

prevalence of P. Falciparum and P. Vivax malaria

was 50% each. Among female patients, 58 were

diagnosed for P. Falciparum malaria and 48 were

diagnosed for P. Vivax malaria. Prevalence of P.

Falciparum malaria was high in age group of 31-

40 years in both male and female. Prevalence of

Vivax malaria was high in age group of 31-40

30 years in female as per

Hyponatremia and hypokalemia were

more common in both P. Falciparum and P.

Vivax malaria. Severity of hyponatremia and

hypokalemia were more in P. Falciparum than P.

Table – 3.

s of mortality and

morbidity in India is malaria. Approximately 300-

500 million cases of malaria are noted every

than 1 million die each year [9].

P.Falciparum species of malaria is usually

associated with the severe and complicated

emia in the acute stages of

malaria did not usually affect the mortality and

Fryatt RJ, et al. [11]. Mild

the malaria patients were also

There was a gradual

sodium and potassium ion levels

within 12 hours of the parasite’s occupancy as

per Dworak et al. [13]. Ebele J Ikekpeazu, et al.

] also reported reduction in the sodium and

potassium ion level in malaria. Cells lost up to

80 % of their potassium content during the

course of the malaria attack as per Heindricks et

Chairul Yoel, et al. [16] reported that the

concentrations of sodium and potassium were

within normal range in malaria. Information

about changes in levels of electrolytes other




than sodium [7] in cases of falciparum malaria

came from a study involving Thai adults [17

Urinary potassium wasting and hypokalemia are

common complications of severe malaria and

potassium depletion becomes apparent only

with correction of acidosis [18

potassium ions play vital role in water

homeostasis, which is must for survival of all

individuals, so it is advisable to determine their

levels in all cases of P. Falciparum

Bradley, et al. [19].

Conclusion

Electrolyte disturbances like hyponatremia and

hypokalemia are often to occur in both P.

Falciparum and P. Vivax malaria. Severi

hyponatremia and hypokalemia are more

common in P. Falciparum than in P.

malaria. Serum electrolytes must be estimated

in each malaria case to prevent grave

complications.

Acknowledgement

Author acknowledges the immense help

received from the scholars whose articles are

cited and included in references

manuscript. The author is also grateful to

authors / editors /publishers of all those articles,

journals and books from where the literature for

this article has been reviewed and discussed.

References

1. Mishra SK, Mohapatra S, Mohanty

Patel NC, Mohapatra DN. Acute renal

failure in falciparum malaria.

Indian Academy of Clinical Medicine

2002; 3: 141-47.

2. Nchinda TC. Malaria: A re

disease in Africa. Emerging Infectious

Diseases, 1998; 4 (3): 1-8.




7] in cases of falciparum malaria

study involving Thai adults [17].

Urinary potassium wasting and hypokalemia are

ere malaria and

potassium depletion becomes apparent only

with correction of acidosis [18]. Sodium and

potassium ions play vital role in water

homeostasis, which is must for survival of all

individuals, so it is advisable to determine their

alciparum malaria as per

lyte disturbances like hyponatremia and

emia are often to occur in both P.

Falciparum and P. Vivax malaria. Severity of

emia are more

alciparum than in P. Vivax

malaria. Serum electrolytes must be estimated

in each malaria case to prevent grave

the immense help

received from the scholars whose articles are

ferences of this

also grateful to

authors / editors /publishers of all those articles,

journals and books from where the literature for

this article has been reviewed and discussed.

Mishra SK, Mohapatra S, Mohanty S,

Patel NC, Mohapatra DN. Acute renal

failure in falciparum malaria. Journal,

Indian Academy of Clinical Medicine,

Nchinda TC. Malaria: A re-emerging

Emerging Infectious

8.

3. Kocha DK, Agarval P, Kochar SK, Jain R,

Rawat N, Srivasta T. Hepatocyte

dysfunction and hepatic encephalopathy

in plasmodium falciparum malaria.

Journal of Medicine,

4. Park K. Preventive and Social Medicine.

21st

edition, p. 231.

5. Tietz N, Pruden LE, Ander

Electrolytes: In Tietz Funda

Clinical Chemistry.

Saunders Company, USA

6. Kaplan A, Rhona J, Ophein EO, Toivola B,

Lyon W, et al. Water balance,

osmolality, blood gas

electrolytes: In Clinical Chemistry,

Interpretation and Techniques.

edition, Williams and Wilkins, USA

1995.

7. Sowunmi A, Newton CR, Waruiru C,

Lightman S, Dunger DB. Arginine and

vasopressin secretion in Kenyan children

with severe malaria.

2000; 46: 195-99.

8. Harrison. Hyponatr

Principles of Internal Medicine

edition, p. 255.

9. Regional guidelines on the management

of severe falciparum malaria in the level

II hospitals. World Health Organisation

South East Asia regional office, New

Delhi, 2004.

10. Tayler TE, Stricklanad GT. Malaria. In:

Strickland GT. Hunter’s tropical

medicine and emerging infectious

diseases. 8th

edition

Saunders Company, 2000, p.

11. Fryatt RJ, Teng JD, Harries AD, Moody

AH, Hall AP, Forsling

urine electrolyte concentrations and the

vasopressin levels in patients who were

admitted to the hospital for falciparum

malaria. J Trop Georg Med

57-60.


Page 9

P, Kochar SK, Jain R,

Rawat N, Srivasta T. Hepatocyte

dysfunction and hepatic encephalopathy

in plasmodium falciparum malaria. Q

, 2003; 96: 505-12.

Preventive and Social Medicine.

Tietz N, Pruden LE, Andersen S.

Electrolytes: In Tietz Fundamentals of

Clinical Chemistry. 2nd

edition, WB

Saunders Company, USA, 1996.

Kaplan A, Rhona J, Ophein EO, Toivola B,

Lyon W, et al. Water balance,

osmolality, blood gases, Ph and

n Clinical Chemistry,

pretation and Techniques. 4th

Williams and Wilkins, USA,

Sowunmi A, Newton CR, Waruiru C,

Lightman S, Dunger DB. Arginine and

vasopressin secretion in Kenyan children

with severe malaria. J Trop. Pediatr,

Harrison. Hyponatraemia: Harrison’s

Principles of Internal Medicine. 16th

Regional guidelines on the management

of severe falciparum malaria in the level

II hospitals. World Health Organisation,

ast Asia regional office, New

tricklanad GT. Malaria. In:

Strickland GT. Hunter’s tropical

medicine and emerging infectious

edition, Philadelphia: W.B.

Saunders Company, 2000, p. 614-43.

Fryatt RJ, Teng JD, Harries AD, Moody

AH, Hall AP, Forsling ML. The plasma and

urine electrolyte concentrations and the

vasopressin levels in patients who were

admitted to the hospital for falciparum

J Trop Georg Med, 1989; 41(1):




12. Kakkilaya BS. Malaria: In Park’s Textbook

of Preventive and Social M

edition, K Park, Bhanar Sides Bhanot

Publishers, 1997, p. 188-

13. Dworak JA, Miller LH, Whitehouse WC,

Shirosh T. Invasion of the electrolytes by

the malaria parasite. Science

748-50.

14. Ikekpeazu EJ, et al. A study on malaria

parasitemia: Effect on the sodium and

potassium levels. A Journal of Biology

and Medicine, 2010; 2(2):

15. Heindricks RG, Hassan AH, Oulrinde LO,

Akindkani A. Malaria in early childhood.

Annals of Tropical Medicine

316-20.

16. Chairul Yoel. Clinical s

electrolytes description of children with

Source of support: Nil

Conflict of interest: None declared.

Table – 1: Age and sex wise distribution of P. Vivax and P. Falciparum cases.

Age (Years) P. Falciparum

Male

<10 2

11-20 5

21-30 11

31-40 13

41-50 12

>50 4

Total 47

Table – 2: Mean + SD of sodium and potassium ion in P. Falciparum and P. Vivax.

Gender P. Falciparum

Sodium ion

Male 126. 71 + 1.46

Female 126.52 + 1.82




n Park’s Textbook

Preventive and Social Medicine. 15th

Bhanar Sides Bhanot

-202.

er LH, Whitehouse WC,

. Invasion of the electrolytes by

Science, 1975; 187:

A study on malaria

ffect on the sodium and

A Journal of Biology

(2): 20-25.

an AH, Oulrinde LO,

. Malaria in early childhood.

Annals of Tropical Medicine, 1971; 65:

Clinical symptoms and

electrolytes description of children with

malaria an outpatient setting in

kabupaten mandailing natal. Majalah

Kedokteran Nusantara

17. Davis TM, Pukrittayakamee S,

Woodhead JS, Holloway P, Chaivisuth B,

White NJ. Calcium and phosphate

metabolism in acute falciparum malaria.

Clin Sci (Lond), 1991

18. Maitland K, Pamba A, Newton CR, Lowe

B, Levin M. Hypokalemia in children with

severe falciparum malaria. Pediatr Crit

Care Med, 2004; 5: 81

19. Bradley DN, Whicher JT, Lee KE.

In Oxford Textbook of Medicine.

edition, Oxford University Press, UK,

1996, p. 835-863.

None declared.

Age and sex wise distribution of P. Vivax and P. Falciparum cases.

P. Falciparum P. Vivax

Female Male

1 3

7 2

8 9

18 15

17 10

7 8

58 47

SD of sodium and potassium ion in P. Falciparum and P. Vivax.


Sodium ion Potassium ion Sodium ion

1.46 3.02 + 0.51 131.48 + 1.62

1.82 3.08 + 0.68 131.76 + 1.86


Page 10

malaria an outpatient setting in

kabupaten mandailing natal. Majalah

Kedokteran Nusantara, 2007.

Davis TM, Pukrittayakamee S,

Woodhead JS, Holloway P, Chaivisuth B,

White NJ. Calcium and phosphate

olism in acute falciparum malaria.

1991; 81: 297–304.

Maitland K, Pamba A, Newton CR, Lowe

B, Levin M. Hypokalemia in children with

severe falciparum malaria. Pediatr Crit

81–5.

Bradley DN, Whicher JT, Lee KE. Malaria:

In Oxford Textbook of Medicine. 3rd

ition, Oxford University Press, UK,

Female

2

4

13

11

11

7

48

SD of sodium and potassium ion in P. Falciparum and P. Vivax.

Potassium ion

3.24 + 0.41

3.28 + 0.32




Table – 3: Sodium and potassium ion level in malaria cases.

Electrolyte level

Sodium ion 125-128

129-132

>132

Potassium ion <3

3-4

>4




Sodium and potassium ion level in malaria cases.


128 87 11

132 15 72

5 12

31 11

68 77

8 7


Page 11

P. Vivax

Documents

Study of sodium and potassium ion disturbances in malaria at Ahmedabad, Gujarat, India