In our study, potassium abnormalities were more common than sodium abnormalities in hospitalized children with acute febrile diarrheal illnesses, but this finding should be interpreted with caution. In children with acute diarrhea, hypokalemia is expected due to gastrointestinal losses of this electrolyte, and previous studies have consistently reported it as the predominant potassium disturbance. 6 Therefore, the relatively high frequency of hyperkalemia in our cohort was unexpected. Although we repeated elevated potassium results, we could not exclude pseudohyperkalemia because of hemolysis during blood collection, a well-recognized artifact in pediatric practice, particularly in infants, where obtaining blood samples can be technically challenging. 7

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Although hyponatremia and hypokalemia were identified in our study, both occurred at relatively low frequencies. This differs from several previous studies that reported these abnormalities more commonly in children hospitalized with acute diarrheal illness. 4,5 Differences in patient populations, illness severity, and prehospital management may explain the discrepancy. Since most children in our cohort had moderate dehydration, this may have contributed to the lower prevalence of electrolyte disturbances observed.

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Overall, electrolyte abnormalities varied only slightly across age groups. We observed a statistically significant association between age group and potassium abnormalities. Elevated potassium values occurred more frequently among infants; however, this pattern should be interpreted cautiously because pseudohyperkalemia could not be excluded. As this finding may reflect pseudohyperkalemia related to hemolysis during blood collection, it should be interpreted cautiously.

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Another important finding was the lack of a significant association between electrolyte abnormalities and dehydration severity. Neither sodium nor potassium abnormalities were significantly associated with clinically assessed dehydration severity. Although electrolyte disturbances often become more pronounced as dehydration worsens and have been associated with dehydration severity in previous studies, 5 our findings suggest that dehydration severity alone may not reliably predict electrolyte imbalance in hospitalized children with acute febrile diarrheal illnesses. This may be because serum electrolyte concentrations are influenced by several factors, including diarrhea duration, the composition of gastrointestinal fluid losses, oral fluid intake, and any fluid replacement received before hospitalization. These findings highlight the importance of laboratory assessment, as clinical evaluation of dehydration alone may not accurately identify children with electrolyte abnormalities. The present study was not designed to determine whether routine or selective electrolyte testing is preferable for hospitalized children with acute febrile diarrheal illnesses. Prospective studies should evaluate which clinical criteria best identify children who would benefit from electrolyte testing and whether testing strategies improve clinical management, outcomes, and resource use.

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Our study has several limitations to consider when interpreting the results. As A single-center retrospective cross-sectional study, the findings may not be generalizable to other populations. In addition, although all patients required hospitalization despite any prehospital measures, possible oral or intravenous fluid administration before arrival may have influenced admission electrolyte concentrations. Therefore, the results represent electrolyte values measured at hospital admission after the patient's prehospital course, rather than untreated electrolyte values. The dehydration categories were markedly imbalanced, with 176 patients classified as having moderate/some dehydration and only 14 as having severe dehydration. This imbalance limited the precision and statistical power of between-group comparisons. Accordingly, the absence of a statistically significant association should not be interpreted as evidence of no association. Despite these limitations, our study provides contemporary data on sodium and potassium abnormalities among hospitalized children with acute febrile diarrheal illnesses in Georgia, where published evidence remains scarce. This publication helps to address this important gap in the local literature. Further prospective, multicenter studies are needed to better define the prevalence and clinical significance of electrolyte abnormalities in this population.