Diarrhea is still a leading cause of mortality and morbidity over the world [1]. Acute diarrhea presents to primary health units are often managed with the goal for care of dehydration, prevention of the spread of infection, and empirical antibiotic in selected cases with fewer investigations done. Acute diarrhea can be attributed to viral, bacterial, and protozoan infection [2]. The peak age of presentation is although< 5 years many episodes of acute diarrhea with hospitalization with worse dyselectrolytemia is very common in elderly >60 years age group [1-4]. Acute diarrhea is defined as the passage of 3 or more loose stools in 24 hours. It is an endemic condition in India with a prevalence of 7% [1,5]. Electrolytes are lost in the diarrheal fluid, mainly Na⁺, K⁺, Cl^-, HCO₃^-. Also, sodium and water reabsorption in the bowel is inhibited. Due to the loss of sodium and water in diarrhea, the body tries to retain sodium under the influence of aldosterone. To maintain intracellular pH, other cations like K⁺ and Mg²⁺ are pushed out of the cells and lost in the urine. This aggravates hypokalemia and hypomagnesemia [5]. Inadequate and inappropriate fluid replacement and many underlying comorbidities and drugs, environmental factors contribute to dyselectrolytemia even if the dehydration is corrected. Unrecognized or poorly treated electrolyte imbalance can lead to significant morbidity and even mortality. Though studies have revealed a deficiency in serum Magnesium, Calcium, and phosphate levels in acute dehydrating diarrhea still rarely these levels are estimated as routine investigations [3,4]. If the loss of these electrolytes is known, a correct replacement can be begun before signs and symptoms of disturbed calcium, magnesium imbalance appears and that can hasten recovery [6].

The epidemiology of hospitalization associated with acute diarrheas in adults is not well been investigated so far, even though it imposes a major burden on the patient and health care system. Although Serum Sodium and Potassium levels are routinely done in patients of acute gastroenteritis whereas Serum Calcium and Magnesium are not routinely studied. Hence, this study was undertaken to study the changes in the level of serum calcium and magnesium in patients of acute gastroenteritis and correlating it with other electrolytes, the total number of vomiting and loose stools, duration of hospital stay.

Sampling procedure: All patients presenting with acute gastroenteritis and fulfilling the inclusion and exclusion criteria were included in the study. Blood was collected in a clean and dry test tube and was allowed to clot. Then it was centrifuged for 3 minutes and the clear supernatant fluid was collected for estimation. The volume of the sample -150µl. Demographic, medical, laboratory records from the participants were collected and documented in a predesigned format. Data were analyzed using MS excel, XPSS Software, One way ANOVA. All categorical variables were described as percentages and continuous variables were expressed as mean and standard deviation. Regression analysis was done and r values were obtained statistical significance was declared if p<0.05.

Ethical issue: The study was approved by the institutional ethics committee.

In, the present study, out of 100 patients, 56% were male and 44% were female (Fig 1). Maximum patients were of the age group 26-35(24%) with an age range from a minimum of 17 years to maximum age of 80 years. The mean age was 42.14 ± 16.153 (Fig-1).

Fig-1: Age and Sex distribution of cases.

Total cases with a value of ≤135 mmol/l were 48% (Fig-5). The values of serum potassium documented were a minimum of 1.5 mmol/l to a maximum of 5 mmol/l with a mean of 3.366 mmol/l±0.6.6726. The majority of cases were in the range of 2.6-3.5 mmol/l (36%). Total cases with a value of serum potassium ≤3.5 mmol/l were 59% (Fig-6).

Fig-5: Categorization of cases according to serum sodium level.

Fig-6: Categorization of cases according to serum potassium level.

The range of serum calcium obtained was 6.7 to 9.8 mmol/l (mean 8.223mmol/L±0.5590). The majority of cases were in the range of 8.1-8.5 mmol/l (57%) followed by 21 cases of serum Calcium value within 6.7-8 mmol/l (Fig-7). About the levels of serum magnesium, the range obtained was 1.1 to 2.9 mg/dl (mean1.710 mg/dl±0.3935). The majority of cases were in the range of 1.7-1.9 mg/dl (35%).

**Correlation is highly significant at .01

DOHS-Days of hospital stay/Sf-stool frequency/ Vf-vomiting frequency

Correlation between magnesium and total episodes of vomiting having r value (– 0.475) with p-value <0.05. Correlation between magnesium and total episodes of vomiting having r value – 0.498 with p-value <0.05.

In a study by Patel et al [9], there were 71 males and 29 females in cases of acute diarrhea. Maximum numbers of cases were between the ages of 21-50 years. In a study by Rajoor UG et al [10], out of 100 patients of acute diarrhea studied, 57 were males and 43 were females. The age of patients varied from 18-90 years. Maximum incidence (60%) was seen in the age group of 21-50 years. In the study by KC M et al [11], out of sixty patients, 38 (63.3%) were male and 22 (36.67%) were female. The finding of the above studies supports the observations of the current study.

Hypocalcemia was seen in 97% (Mean of 8.22±0.56) of the study population. The majority (57%) had serum calcium lying between 8.1 to 8.5 mmol/L followed by 6.7 to 8 mmol/L (21%) and 8.5 to 9 mmol/L (19%) which was similar to the finding of Anjali et al [8] whereas hypocalcemia was present in 94% of patients in the study conducted by Bhikha et al. [7]. This difference is because of the altered cut off value for defining hypocalcemia (<8.5 mg/dl) in the study.

In the present study, hypomagnesemia (less than 1.7 mg/dl) was seen in 49% of the study population. The majority of the population (29%) had serum magnesium lying between 1.5 to 1.6 mg/dl followed by 1.1 to 1.4 mg/dl (20%). The minimum serum magnesium level was 1.1 mg/dl and the maximum was 2.9 mg/dl with a mean of 1.71±0.39 mg/dl. The findings are comparable to Patel et al [9] where 55% had hypomagnesemia on admission and 6% cases had severe hypomagnesemia. Hyponatremia was seen in 48% of the study population. The majority of the population (28%) had hyponatremia with serum sodium lying between 130.1 to 135 mmol/L followed by 120 to 130 mmol/L (20%) compared to 35% of the study population had hyponatremia in the study of Anjali et al [8] and lower than the study by Patel et al [9] (80%).

In the present study, hypokalaemia was seen in 59% of the study population. The minimum serum potassium level was 1.5 mmol/L and the maximum was 5.1 mmol/L with a mean of 3.37±0.98. mmol/L. The majority of the population (36%) had hypokalaemia with serum potassium lying between 2.6 to 3.5 mmol/L followed by 1.5 to 2.5 mmol/L (23%) compared to Patel et al [9] were 39% cases had hypokalaemia on admission and 22% cases had severe hypokalaemia higher than 23% of study by Anjali et al [8].

The correlation of serum magnesium levels with serum potassium level has a Pearson coefficient, r value 0.801 with a p-value < 0.05, the serum magnesium level is directly proportional to serum potassium level; which was found to be statistically significant. The changes in serum magnesium level have a stronger association with serum potassium level than serum sodium levels.

The correlation of serum magnesium levels with a duration of hospital stay has Pearson coefficient, r value – 0.699 with a p-value < 0.05. The serum magnesium level is inversely proportional to the duration of hospital stay; which was found to be statistically significant. The correlations described above have never been earlier studied in the adult population in patients of acute gastroenteritis.

The sample size was only 100. So, it may not have been represented by the target population. Electrolyte estimation was done only on admission. A comparative data on admission versus on discharge would throw light on how the treatment influences the electrolyte imbalance it would also point out the limitations of conventional treatment protocols.

Secondly, stool levels of Mg²⁺, K⁺, Ca^2+, and urinary Mg²⁺, K⁺ levels could not be measured to document the loss of Mg ²⁺ and Ca²⁺ in stool and Mg²⁺ and K⁺ loss in urine due to non-availability of these investigations at our set up.

In the present study, hypocalcemia (97%), hypokalemia (59%), hypomagnesemia (49%), and hyponatremia (48%) were reported. Therefore, serum electrolytes such as calcium, magnesium should also be investigated along with routine serum sodium and potassium. Early detection and prompt correction of electrolytes will be beneficial as it will decrease the duration of hospital stay, morbidity, the mortality of patients and will decrease the burden on the health system of the country.

Also, adequate measures should be taken for the prevention and control of acute gastroenteritis.