Background: Co-morbidities are the reason behind high morbidity and mortality in SAM children. There is lack of literature regarding co morbidity pattern in SAM children. Aim: The aim of the study was to evaluate the spectrum of co-morbidities in severe acute malnutrition with unexpected dyselectrolytemia in diarrhea. Material and Methods: The study was a observational study which was carried in the Department of Pediatric, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India for 1 year. Total 120 Children below 6 year age were included in this study. Various co morbid conditions in study population were identified. All the laboratory examination were done with standard method. Results: Total 120 cases were included in study of which 95% were associated co-morbid conditions in SAM. Majority of children with SAM were having co-morbidity in the form of Anaemia (86.67%), Diarrhoea (64.17%) followed by pneumonia (28.33%), Rickets (25.83%), Tuberculosis (15.83%), Otitis media (13.33%), UTI (10.83%), Celiac (5.83%), Hypothyroidism (1.67%), & HIV (0.83%). 77 (64.17%) SAM children presented with diarrhea of which 76 had dysnatremia in the form of Hyponatremia in 76 cases (63.33%) & Hypernatremia in 2 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 25% SAM children were having hypokalemia. Hypokalemia was found in 15.83% of diarrheal cases & 9.17% in non- diarrheal cases. A statistically significant difference was found with hypokalemia in SAM (P value of 0.029) 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.