Aim: The aim of the study to evaluate the spectrum of co-morbidities in severe acute malnutrition with unexpected dyselectrolytemia in diarrhea. Methods: The study was an observational study which was carried in the Department of Pediatrics, Vardhman Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India for the period of 1 year. Total 300 children below 6 year age were included in this study. Various co morbid conditions in study population were identified. All the laboratory examination was done with standard method. Results: Majority of children with SAM were having co-morbidity in the form of Anaemia (84%), Diarrhoea (66.67%) followed by pneumonia (26.67%), Rickets (26%), Tuberculosis (15.33%), Otitis media (11.33%), UTI (9.33%), Celiac (5.33%), Hypothyroidism (2.67%), & HIV (2%). Mean age (SD) of the diarrheal cases was 4.1 months (95% C.I. 24.5- 27.6) of which 56 were male (56%). Mean age (SD) of non-diarrheal cases was 2.1. (95% C.I. 19.2 – 22.7) of which 78% were male. 100(66.67%) SAM children presented with diarrhea of which Hyponatremia in 75 cases (72.11%) & Hypernatremia in 3 cases No statistically significant difference was found with hyponatremia in diarrheal or non-diarrheal cases of SAM(P value of 0.09). It was found that 23.33% SAM children were having hypokalemia. Hypokalemia was found in 25% of diarrheal cases & 20% in non- diarrheal cases. Potassium levels of children with diarrheal & non diarrheal children with SAM. A statistically significant difference was found with hypokalemia in SAM (P value of 0.027) between Diarrheal & Non diarrheal cases. Conclusion: Co-morbidities identification and treatment in SAM children is key step in reducing morbidity and mortality associated with SAM.