Understanding and Managing Electrolyte Imbalances

October 06 05:34 2023 by admin Print This Article

Summary

Electrolytes are a class of seven minerals that are abundantly found in nature, and also in the human body. They perform various functions and are critical for good overall health of a human being. Sometimes, due to one or more ailments, one or more of these electrolytes can increase or decrease in levels, and  go out of range. This electrolyte imbalance leads to various complications, if not treated on time. In very rare cases, electrolyte imbalance can also be fatal. In this article, we will learn more.

What are Electrolytes?

Electrolytes are a class of seven different minerals found in the human body. Their name comes from the fact these are electrically charged ions, chemically speaking. They give off an electrical charge (either positive or negative) when they dissolve in body fluids such as urine or blood. They are found widely inside the human body, in several tissues and body cells. They are made by the body, and they are also absorbed from the food, beverages, water and medication that we consume.

Electrolytes perform various functions required for day-to-day health and normal functioning of the body. The number of pluses or minuses given in brackets, against the name, indicates how many positive or negative ions are created.

1. Sodium (Na⁺): This controls fluid levels in the body and enhances nerve and muscle functionality. The Latin word for Sodium is Natrium.
2. Potassium (K⁺): This is responsible for moving nutrients into cells from the blood, and moving waste products out of the cell and into the blood for further processing. They play an important role in nerve, muscle and heart function. They are important for our overall metabolism. The Latin word for Potassium is Kalium.
3. Calcium (Ca²⁺): We normally think of calcium to be present in the bones alone. However, it is widely present in the body. It is a key for vascular function by helping blood-vessels expand and contract, thereby stabilizing the blood pressure. It also helps in the secretion of hormones and enzymes that aid the nervous system in sending and receiving messages.
4. Magnesium (Mg²⁺): This too supports muscle and nerve function. It is also important for the healthy growth of bones and teeth.
5. Chloride (Cl^–): This helps maintain healthy levels of body fluids, blood and blood pressure.
6. Phosphate (PO₄^3-): This is important for the skeletal system. It also boosts muscle and nerve function.
7. Bicarbonate (HCO^3-): This helps transport dissolved carbon-di-oxide in the blood to the lungs where they are exhaled out as a gas. It also helps maintain the balance of acidic and alkaline compounds in the blood. This aspect is called the pH balance.

In addition, electrolytes help in blood clotting and formation of new cells.

What is Electrolyte Imbalance?

Sixty-six percent of the human body is made up of water. Water is found in the blood (83 percent), inside body-cells and around body-cells called as fluid compartments. The water level in the fluid compartments must be maintained at optimum levels. This is achieved by the kidneys, liver, and certain other organs and tissues of the body. They achieve this by moving electrolytes in and out of these fluid compartments.

Sometimes, certain ailments or diseases can affect the body’s ability to move the electrolytes in and out seamlessly. As a result, there are too much of or too less of one or more electrolytes in the fluid compartments. This situation is called an Electrolyte Imbalance.

Causes and Risk factors

Causes for electrolyte imbalance vary from electrolyte to electrolyte and depending on whether the level is higher or lower than normal. This will be covered in a later section. But there are certain risk factors for the same.

• Age: Infants, children and seniors are more at risk that adults (18-59 years of age)
• Medications such as diuretics, antibiotics, laxatives, chemotherapy drugs and corticosteroids
• Cancer
• Not eating and drinking enough
• Burns
• Cardiovascular disease (CVD), heart failure and hypertension
• Liver disease like cirrhosis
• Dehydration from not consuming enough fluids
• Dehydration due to severe diarrhoea, vomiting, sweating or fever
• Overhydration due to consuming too much fluids
• Chronic respiratory diseases
• Eating disorders such as bulimia and anorexia
• Kidney disease
• Complications due to substance abuse
• Metabolic alkalosis: here, the blood pH is higher than normal
• Thyroid disorders

Symptoms and signs

• Alkalosis
• Bone pain
• Coma
• Confusion and irritability, agitated nature
• Constipation
• Cramps
• Delirium
• Difficulty breathing
• Dizziness
• Dry mouth and thirst
• Fatigue or weakness
• Frequent urination
• Headaches
• Heart rhythm abnormalities (arrhythmias)
• Increased or decreased urine output
• Insomnia
• Itching
• Low or high blood pressure
• Metabolic acidosis
• Muscle cramps, muscle spasms or weakness
• Myoglobinuria
• Nausea, vomiting, or diarrhoea
• Numbness or tingling in limbs, fingers and toes
• Poor coordination when walking
• Restlessness
• Rhabdomyolysis
• Seizures in severe cases
• Tachypnea, which is rapid, shallow breathing

Types of Electrolyte imbalance and causes

There are 14 types of Electrolyte imbalance. Seven electrolytes multiplied by 2 states – higher than normal level (hyper) or lower than normal level (hypo).

Sodium

• Hypernatremia: Caused by inadequate consumption of fluids, or excessive loss of body fluids due to prolonged diarrhoea, vomiting or sweating
• Hyponatremia: Caused by vomiting or diarrhoea, certain medications such as diuretics and seizure medications, poor nutrition, liver, heart, or kidney failure, alcohol abuse complications, syndrome of inappropriate secretion of antidiuretic hormone (SIADH), overhydration or excessive consumption of fluids and thyroid or adrenal disorders

Potassium

• Hyperkalemia: Caused by severe dehydration, adrenal insufficiency, a condition in which the cortisol levels are too low, kidney failure, certain medications such as blood-pressure medicines and diuretics, severe acidosis, including diabetic ketoacidosis
• Hypokalemia: Caused by eating disorders such as bulimia and anorexia, certain medications such as corticosteroids, diuretics and laxatives, severe vomiting or diarrhoea

Calcium

• Hypercalcemia: Caused by kidney disease, medications such as diuretics, lithium or theophylline, excessive use of vitamin D supplements, calcium supplements and antacids, certain cancers such as breast and lung, lung infections such as tuberculosis or sarcoidosis and hyperparathyroidism
• Hypocalcemia: Caused by kidney failure, certain medications such as osteoporosis drugs, chemotherapy drugs, anti-convulsant drugs and some diuretics, prostate cancer, malabsorption, hypoparathyroidism, pancreatitis and vitamin-D deficiency

Magnesium

• Hypermagnesemia: Caused by hypothyroidism, Addison’s disease and acute or chronic kidney disease
• Hypomagnesemia: Caused by alcohol abuse complications, certain medications such as diuretics and antibiotics, malnutrition, diarrhoea and malabsorption

Chloride

• Hyperchloremia: Caused by severe dehydration, metabolic acidosis and kidney failure
• Hypochloremia: Caused by metabolic alkalosis, extreme fluid loss due to vomiting or diarrhoea, diuretics and chronic respiratory acidosis

Phosphate

• Hyperphosphatemia: Caused by chronic kidney disease, excessive use of phosphate-rich laxatives, severe breathing trouble, tumour lysis syndrome (a complication of cancer treatment), underactive parathyroid glands and severe muscle injury
• Hypophospatemia: Caused by acute alcohol abuse, certain medications such as antacids, severe burns, overactive parathyroid glands, refeeding syndrome and vitamin D deficiency

Bicarbonate

• Metabolic alkalosis: Caused by respiratory diseases like chronic obstructive pulmonary disease (COPD), adrenal gland problems such as Cushing’s syndrome or Conn’s syndrome, dehydration and anorexia
• Metabolic acidosis: Caused by Kidney disease, Aspirin overdose, Diabetic ketoacidosis, Ethylene glycol poisoning and Addison’s disease

Diagnosing Electrolyte imbalance

• Physical test: To look for visible signs of electrolyte imbalance
• Pinch test: This tests the elasticity of the skin as hypernatremia can cause inelastic skin
• Blood Tests: A electrolyte serum test, also called metabolic panel test that measures the levels of sodium, calcium, potassium, magnesium and chloride.
• Urine Tests: A urinalysis can assess both electrolyte levels and kidney function.
• Kidney Function Test: This is done along with or in place of urine test.
• An arterial blood gas (ABG) test: This helps determine the acid-base status in the blood.
• An electrocardiogram (ECG) to check for heart rhythm problems.

Treatment

• Intravenous (IV) fluids: These typically contain sodium chloride and can help rehydrate the body.
• Certain IV medications: These help the body restore electrolyte balance quickly and includes calcium gluconate, potassium chloride and magnesium sulphate
• Oral medications and supplements: These are given to correct chronic electrolyte imbalance and includes calcium gluconate, calcium lactate, calcium carbonate, calcium citrate, potassium chloride, magnesium oxide and phosphate binders such as sevelamer hydrochloride and lanthanum
• Haemodialysis: This is a type of dialysis that primarily removes waste from the blood using a machine

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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