BACKGROUND: Several metabolic derangements and electrocardiographic changes occur in protein energy malnutrition (PEM) which increases the morbidity and mortality in these patients. METHODS: This was prospective observational study conducted at tertiary pediatric hospital in north India. Total of 75 patients were enrolled as cases (with PEM) and 75 age and sex matched controls were taken without PEM. The electrolyte and ECG findings were recorded at the time of admission and compared with the controls. RESULTS:There was significantly decreased serum sodium, potassium and calcium levels in PEM as compared to controls (p<0.001). Prolongation of PR interval and QTc was significant in severe PEM as compared to controls (p<0.001). CONCLUSION:Dyselectrolytemia and electrocardiographic changes are common in patients with severe malnutrition which needs urgent attention for appropriate management.