Electrolyte imbalance, or water-electrolyte imbalance, is an abnormal concentration of electrolytes in the body. Electrolytes play a vital role in maintaining homeostasis in the body and serve in many biological processes. Anions are as well known form of electrolytes and include things like calcium, magnesium, potassium, though electrolytes can form differently charged types of ions in solution (or when melted). Cations (or positively charged ions), i.e.sodium ions, are a well-known form of electrolytes. A combination of sodium (Na) with a chloride anion. Other forms of anions are for example chloride phosphate ions) and are anions (negatively− charged). Electrolytes cross barriers in (cellular membranes) in the body, such as in muscles and nerves, in the intestine, and filtered (to be controlled) by the kidney (as well as the intestine filtering minerals, for example magnesium).
Electrolytes help to regulate heart and neurological function, fluid balance, oxygen delivery, acid–base balance for example. Electrolyte imbalances can develop by consuming too little or too much electrolyte as well as excreting too little or too much electrolyte. Examples of electrolytes include calcium, chloride, magnesium, phosphate, sodium, and potassium. Electrolytes levels in the blood (used to calculate the anion gap) are Chloride (as Cl-) + bicarbonate (HCO3-, used as a buffer to control the amount of Co2 in the blood) - Sodium (Na+) + Potassium (K+). The causes, severity, treatment, and outcomes of these disturbances can differ greatly depending on the implicated electrolyte. The most serious electrolyte disturbances involve abnormalities in the levels of sodium, potassium or calcium. Other electrolyte imbalances are less common and often occur in conjunction with major electrolyte changes. The kidney is the most important organ in maintaining appropriate fluid and electrolyte balance, but other factors such as hormonal changes and physiological stress play a role.
Malnutrition
People with malnutrition are at especially high risk for an electrolyte imbalance. Severe electrolyte imbalances must be treated carefully as there are risks with overcorrecting too quickly, which can result in arrhythmias, brain herniation, or refeeding syndrome depending on the cause of imbalance. Restrictive eating disorders such as anorexia nervosa and atypical anorexia nervosa are also associated with electrolyte imbalance.
General function of electrolytes
Electrolytes are important because they are what cells (especially nerve, heart and muscle cells) use to maintain voltages across their cell membranes. Electrolytes have different functions, and an important one is to carry electrical impulses between cells. Kidneys work to keep the electrolyte concentrations in blood constant despite changes in the body.
Treatment of electrolyte imbalance depends on the specific electrolyte involved and whether the levels are too high or too low. The parathyroid gland is responsible for sensing changes in calcium concentration and regulating the electrolyte with parathyroid hormone.
Hypercalcemia
Hypercalcemia describes when the concentration of calcium in the blood is too high. This occurs above 10.5 mg/dL.
Causes
Hypoparathyroidism and vitamin D deficiency are common causes of hypocalcemia. Most of the chloride in the body is from salt (NaCl) in the diet. Chloride is part of gastric acid (HCl), which plays a role in absorption of electrolytes, activating enzymes, and killing bacteria. The levels of chloride in the blood can help determine if there are underlying metabolic disorders. Generally, chloride has an inverse relationship with bicarbonate, an electrolyte that indicates acid-base status.
Treatment
Treat the underlying cause, which commonly includes increasing fluid intake.
Treatment
Treat the underlying cause, which commonly includes increasing fluid intake. Magnesium is important in control of metabolism and is involved in numerous enzyme reactions. A normal range is 0.70 - 1.10 mmol/L. This is defined by a magnesium concentration >2.5 mg/dL.
Causes
Hypermagnesemia typically occurs in individuals with abnormal kidney function. This imbalance can also occur with use of antacids or laxatives that contain magnesium. Iatrogenic cases of hypermagnesemia can be prevented by avoiding magnesium-containing medications.
Symptoms
Mild symptoms include nausea, flushing, tiredness. Neurologic symptoms are seen most commonly including decreased deep tendon reflexes. Severe symptoms include paralysis, respiratory failure, and bradycardia progressing to cardiac arrest.
Treatment
If kidney function is normal, stopping the source of magnesium intake is sufficient. Diuretics can help increase magnesium excretion in the urine. Severe symptoms may be treated with dialysis to directly remove magnesium from the blood.
Hypomagnesemia
Hypomagnesemia, or low magnesium levels in the blood, can occur in up to 12% of hospitalized patients. Symptoms or effects of hypomagnesemia can occur after relatively small deficits.
Causes
Major causes of hypomagnesemia are from gastrointestinal losses such as vomiting and diarrhea. Another major cause is from kidney losses from diuretics, alcohol use, hypercalcemia, and genetic disorders. Low dietary intake can also contribute to magnesium deficiency.
Symptoms
Hypomagnesemia is typically associated with other electrolyte abnormalities, such as hypokalemia and hypocalcemia. For this reason, there may be overlap in symptoms seen in these other electrolyte deficiencies. Severe symptoms include arrhythmias, seizures, and tetany.
Treatment
The first step in treatment is determining whether the deficiency is caused by a gastrointestinal or kidney problem. People with no or minimal symptoms are given oral magnesium; however, many people experience diarrhea and other gastrointestinal discomfort. Those who cannot tolerate or receive magnesium, or those with severe symptoms can receive intravenous magnesium.
Hypomagnesemia may prevent the normalization of other electrolyte deficiencies. If other electrolyte deficiencies are associated, normalizing magnesium levels may be necessary to treat the other deficiencies.
Phosphate
Hyperphosphatemia
Hypophosphatemia
Potassium
Potassium resides mainly inside the cells of the body, so its concentration in the blood can range anywhere from 3.5 mEq/L to 5 mEq/L. It is a common saying in human physiology that "cells are bags of Potassium floating in a sea of Sodium." Sodium and its homeostasis in the human body is highly dependent on fluids. The human body is approximately 60% water, a percentage which is also known as total body water. The total body water can be divided into two compartments called extracellular fluid (ECF) and intracellular fluid (ICF). The majority of the sodium in the body stays in the extracellular fluid compartment. This compartment consists of the fluid surrounding the cells and the fluid inside the blood vessels. ECF has a sodium concentration of approximately 140 mEq/L.