Aim: to evaluate the spectrum of co-morbidities in severe acute malnutrition with unexpected dyselectrolytemia in diarrhea. Material and Methods: The study was an observational study which was carried in the Department of Pediatrics, Anugrah Narayan Magadh Medical College and Hospital Gaya, Bihar, India for 15 months. Total 100 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: out of 100, 94% were associated co-morbid conditions in SAM. Majority of children with SAM were having co-morbidity in the form of Anaemia (85%), Diarrhoea (63%) followed by pneumonia (30%), Rickets (28%), Tuberculosis (15%), Otitis media (14%), UTI (10%), Celiac (5%), Hypothyroidism (3%), & HIV (2%). Mean age (SD) of the diarrheal cases was 37(6) months (95% C.I. 23.7- 26.5) of which 37 were male (58.73%). Mean age (SD) of non-diarrheal cases was 28(6). (95% C.I. 16.6 – 19.4) of which 75.67% were male. Among 100, 63 (63%) SAM children presented with diarrhea of which 62 had dysnatremia in the form of Hyponatremia in 62 cases (62%) & Hypernatremia in 2 cases (1%) No statistically significant difference was found with hyponatremia in diarrheal or nondiarrheal cases of SAM (P value of 0.08). Serum Potassium levels of 100 SAM children were analysed. It was found that 22% SAM children were having hypokalemia. Hypokalemia was found in 13% of diarrheal cases & 9% in non- diarrheal cases. A statistically significant difference was found with hypokalemia in SAM (P value of 0.023) between Diarrheal & Non diarrheal cases. Conclusion: we conclude that dyselectrolytemia is high in complicated SAM and mainly sodium disturbances in form of hyponatremia are common in different co-morbid conditions. Hence, we recommend that due care is to be given for management of dyselectrolytemia in complicated SAM children.