The frequency of electrolyte disturbances in children with febrile neutropenia and it's i̇mpact on clinical outcome

Introduction: The most common malignancy in childhood is acute leukemia. Febrile neutropenia (FN) is a life threatening emergency condition in patients with acute leukemia. There are many studies evaluating a number of different factors affecting the clinical course and prognosis of febrile neutropenia. Aim: There are very few studies evaluating the effect of electrolyte disturbances on febrile neutropenia episodes and their impact on clinical outcome, and no studies have been found in pediatric patients. The aim of this study is to investigate the frequency of electrolyte disturbances, the relationship between electrolyte disturbances and the disease type, clinical presentation features, chemotherapy phase, length of stay in hospital and prognosis in children with acute leukemia and febrile neutropenia. Methods: Our study included patients with acute leukemia who were followed-up by the Department of Pediatric Hematology of the Faculty of Medicine of Dokuz Eylul University between September 2016 and September 2018, who were admitted to the pediatric emergency department or the pediatric hematology outpatient clinic, or who developed FN during hospitalization in the hematology service or the bone marrow transplantation unit. If more than one FN episode developed at different times in the same patient, all episodes were included in the study separately. On hundred eighteen FN episodes, developed in 36 patients at the time of initial diagnosis or after chemotherapy or during bone marrow transplantation were evaluated prospectively. Clinical features, electrolyte levels and other laboratory data of patients at the time of development of FN were recorded in data collection forms. Results: During the study period, an average of 2,9±2,1 (1-11) FN episodes were observed per patient. Febrile neutropenia diagnoses were made 42,4% at the inpatient clinic, 32,2% at the pediatric hematology outpatient clinic and 25,4% at the pediatric emergency department. In 60,2% of the patients, electrolyte disturbance was detected at the time of a FN episode. Hypophosphatemia was found in 31,4% of the episodes, hyponatremia in 6,9%, hypocalcemia in 16,1%, hypopotassemia in 11,9%, hypochloremia in 5,1%, and hypomagnesemia in 3,4%. In most of the episodes, low electrolyte levels was mild as in the grade 1. Intravenous electrolyte replacement was performed in 33,1% of febrile neutropenia episodes. Hyponatremia was more frequent in patients with acute lymphoblastic leukemia and hypophosphatemia in patients with acute myeloid leukemia. During FN episodes electrolyte abnormalities were found in 89,5% of patients with diarrhea, 79,1% of patients with nausea and vomiting and 73,7% of patients with decreased oral intake and the frequency of electrolyte abnormalities was significantly higher than patients without these conditions. The duration of hospital stay in patients with electrolyte abnormality was 31,7±27,9 days (4-174 days), while it was significantly shorter with 16,4±15,8 days (3-64 days) in patients without electrolyte abnormality. Electrolyte abnormalities were more frequent in patients with FN episodes at salvage chemotherapy. Two patients who required intensive care had electrolyte abnormalities necessitating intravenous replacement. There was no mortality due to febrile neutropenia in our patients during the study period. Conclusion: In this study, we found that electrolyte abnormalities and the need for electrolyte replacement were common in children with acute leukemia at the time of FN episodes. We found that electrolyte abnormalities were more frequent in patients with febrile neutropenia with gastrointestinal complaints. The duration of hospital stay was longer in episodes with electrolyte abnormalities. Further studies are needed to determine the effects of electrolyte abnormalities on prognosis and treatment costs in this patient group. Keywords: Febrile neutropenia, acute leukemia, electrolyte abnormalities