POTASSIUM SUPPLEMENTATION IN KWASHIORKOR

Background: Kwashiorkor is an edimatous form of severe malnutrition an d is the predominant form of childhood malnutrition in Malawi. Potassi um depletion is common and contributes to the high mortality. The aim of this study was to deter mine if high potassium supplementation impr oves the outcome of kwashiorkor treatment. Methods: We performed a ran domised, double-blind, placebo-controlled, clinical trial of high pota ssium supplementation in 99 children with kwashiorkor. Controls (n = 5 1) received a standard potassium intake of 4.7 mmol/kg/day. The interv ention group (n = 48) received 7.7 mmol/kg/day. All cases (interventio n and control groups) were treated in the hospital-based Nutrition Reh abilitation Center and received a standard treatment regime of mild fe eds, mineral and vitamin supplements, and antibiotics. Results: There was no significant difference in length of hospitalization, or time fo r resolution of oedema between groups. The case-fatality rate was redu ced by 33% in the high potassium intervention group (13/48) compared t o controls (21/51). There was a significant reduction in late deaths ( 13 in controls vs 3 in intervention group; odds ratio 5.3, 95% confide nce interval 1.2-31.0) but no difference in early deaths (0-5 days). T he intervention group also had significantly fewer presumed septic epi sodes (3 vs 18, odds ratio 8.9, confidence interval 2.2-50.9), respira tory symptoms, and new skin ulcerations than controls. Conclusions: Th e high potassium supplementation reduced mortality and significant mor bidity in kwashiorkor. This may be due to improved myocardial and immu ne function from earlier repletion of intracellular potassium. We reco mmend that the standard potassium supplement for the initial phase of treatment of kwashiorkor be increased from 4 to 8 mmol/kg/day. (C) 199 7 Lippincott-Raven Publishers.