Prevalence of Electrolyte Imbalance in Hypoxic-ischemic Encephalopathy: A Hospital-based Prospective Observational Study

Document Type: Original Article


1 World College of Medical Sciences, Haryana, India

2 Vikas Hospital, New Delhi, India


Background: The present study aimed to investigate the prevalence of electrolyte imbalance in hypoxic-ischemic encephalopathy (HIE). Moreover, the correlation of this condition with Apgar score is evaluated.
Methods: This prospective observational hospital-based study was conducted on 75 neonates affected by asphyxiation. Immediately (within ≤ 30 min of stabilization) after resuscitation, basic routine tests along with sodium (Na+), potassium (K+), and calcium (Ca++) were requested from laboratory to be quantitatively estimated. These neonates were clinically examined and classified into various stages of HIE according to recommended staging classification.  The values of electrolytes were calculated and compared between various stages of HIE. Furthermore, the correlation between these electrolytes and Apgar score was assessed.
Results: It was observed in our study that HIE is associated with low levels of sodium and calcium. On the other hand, it is correlated with high levels of potassium. As severity of HIE increases, sodium and calcium levels decrease, while potassium level augments. Apgar score was significantly correlated with sodium and potassium. However, the correlation of potassium and sodium with Apgar score was shown to be negative and positive, respectively. Calcium levels did not have a significant correlation with Apgar score.
Conclusion: Electrolyte imbalances, such as hyponatremia, hyperkalemia, and hypocalcemia are common in HIE. Hyponatremia and hyperkalaemia are significantly correlated with Apgar score. Therefore, Apgar score can be used as a determinant to start electrolyte therapy in HIE.


1. Cloherty JP, Eichenwald EC, Hansen AR, Martin CR, Stark AR. Cloherty and Stark’s manual of new-born care. Perinatal asphyxia and hypoxic-ischemic encephalopathy. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2015. P. 790.

2. Bhimte B, Vamne A. Metabolic derangement in birth asphyxia due to cellular injury with reference to mineral metabolism in different stages of hypoxicischemic encephalopathy in central India. Indian J Med Biochem. 2017; 21(2):86-90.

 3. Wu YW, Backstrand KH, Zhao S, Fullerton HJ, Johnston SC. Declining diagnosis of birth asphyxia in California: 1991–2000. Pediatrics. 2004; 114(6): 1584-90.

 4. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010; 375(9730):1969-87.

 5. Bauer K, Versmold H. Postnatal weight loss in preterm neonates less than 1500 g is due to isotonic dehydration of the extracellular volume. Acta Paediatr Scand Suppl. 1989; 360:37-42.

 6. Wu PY, Hodgman JE. Insensible water loss in preterm infants: changes with postnatal development and non-ionizing radiant energy. Pediatrics. 1974; 54(6):704-12.

 7. Low JA, Panagiotopoulos C, Derrick EJ. Newborn complications after intrapartum asphyxia with metabolic acidosis in the term foetus. Am J Obstet Gynecol. 1994; 170(4):1081-7.

 8. Tsang RC, Chen IW, Friedman MA, Chen I. Neonatal parathyroid function: role of gestational age and postnatal age. J Pediatr. 1973; 83(5):728-38.

9. Tsang RC, Kleinman LI, Sutherland JM, Light IJ. Hypocalcemia in infants of diabetic mothers: studies in calcium, phosphorus, and magnesium metabolism and parathormone responsiveness. J Pediatr. 1972; 80(3):384-95.

10. Sample size calculator. Raosoft. Available at: URL:; 2018.

 11. Sarnat, HB, Sarnat M. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol. 1976; 33(10):696-705.

 12. Arcara KM. Blood chemistries and body fluids. In: Tschudy MM, Arcara KM, editors. The Harriet lane handbook. 19th ed. Philadelphia: Mosby Elsevier; 2011. P. 639-47.

13. Thakur J, Bhatta NK, Singh RR, Poudel P, Lamsal M, Shakya A. Prevalence of electrolyte disturbances in perinatal asphyxia: a prospective study. Ital J Pediatr. 2018; 44(1):56.

14. Vandana V, Amit V, Meena V, Anuradha B, Vivek B, Deepak V, et al. Study of basic biochemical and haematological parameters in perinatal asphyxia and its correlation with hypoxic ischemic encephalopathy staging. J Adv Res Biol Sci. 2011; 3(2):79-85.

15. Basu P, Das H, Choudhuri N. Electrolyte status in birth asphyxia. Indian J Pediatr. 2010; 77(3):259-62.

16. Jajoo D, Kumar A, Shankar R, Bhargava V. Effect of birth asphyxia on serum calcium levels in neonates. Indian J Pediatr. 1995; 62(4):455-9.

17. Schedewie HK, Odell WD, Fisher DA, Krutzik SR, Dodge M, Cousins L, et al. Parathormone and perinatal calcium homeostasis. Pediatr Res. 1979; 13(1):1-6.