BRAIN CONCUSSION PRODUCES TRANSIENT HYPOKALEMIA IN CHILDREN

Hyperglycemia and hypokalemia caused by catecholamine discharge have b een reported to occur in patients after severe head trauma. The aim of this prospective study was to evaluate whether a similar neuroendocri ne and metabolic response is found in children after minor head trauma such as brain concussion (Glasgow Coma Scale (GCS) greater than or eq ual to 13). One hundred fifty patients aged 2 to 14 years (average, 6 years) were divided into three groups (n = 50 in each group), Group 1 included patients admitted to the emergency department for brain concu ssion (Glasgow Coma Scale (GCS) greater than or equal to 13); group 2 included patients admitted for fractures of long bones without head in jury; and group 3 were control patients electively admitted for hernia repair. All patients had complete physical and neurological examinati ons. Complete blood count and blood chemistry were obtained on admissi on. All blood tests were repeated at 6, 12, and 24 hours in patients b elonging to group 1. An electrocardiogram was obtained in selected pat ients and catecholamine levels were measured in some patients. Statist ical analysis was performed using analysis of variance (ANOVA). Serum potassium and sodium levels in patients with brain concussion (group 1 ) were 3.6 +/- 0.6 and 136 +/- 3 mEq/L, respectively and were signific antly lower (P < 0.01) than those in patients belonging to group 2, 4 +/- 0.4 and 138 +/- 3, respectively, and the controls (group 3), 4.2 /- 0.5 and 140 +/- 2, respectively Serum glucose revel was 124 +/- 34 and 118 +/- 32 mg% in groups 1 and 2 and was significantly higher than that of the controls (group 3), 90 +/- 23 mg%. There was no correlati on between serum electrolytes and GCS. No electrocardiogram changes or elevation of serum catecholamines were found. Hypokalemia resolved sp ontaneously within 24 hours. All patients recovered without neurologic al sequalae. Transient hypokalemia frequently occurs in children even with minor head trauma. This hypokalemia resolves spontaneously, witho ut treatment and within 24 hours. Copyright (C) 1997 by W.B. Saunders Company