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Electrolyte imbalance, or water-electrolyte imbalance, is an abnormality in the concentration of
electrolytes An electrolyte is a medium containing ions that is electrically conducting through the movement of those ions, but not conducting electrons. This includes most soluble salts, acids, and bases dissolved in a polar solvent, such as water. Upon d ...
in the body. Electrolytes play a vital role in maintaining
homeostasis In biology, homeostasis (British English, British also homoeostasis) Help:IPA/English, (/hɒmɪə(ʊ)ˈsteɪsɪs/) is the state of steady internal, physics, physical, and chemistry, chemical conditions maintained by organism, living systems. Thi ...
in the body. They help to regulate heart and neurological function,
fluid balance Fluid balance is an aspect of the homeostasis of organisms in which the amount of water in the organism needs to be controlled, via osmoregulation and behavior, such that the concentrations of electrolytes ( salts in solution) in the variou ...
,
oxygen delivery Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the ci ...
,
acid–base balance In chemistry, an acid dissociation constant (also known as acidity constant, or acid-ionization constant; denoted ) is a quantitative measure of the strength of an acid in solution. It is the equilibrium constant for a chemical reaction :HA A ...
and much more. 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, potassium, and sodium. Electrolyte disturbances are involved in many disease processes, and are an important part of patient management in medicine. 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 Sodium is a chemical element with the symbol Na (from Latin ''natrium'') and atomic number 11. It is a soft, silvery-white, highly reactive metal. Sodium is an alkali metal, being in group 1 of the periodic table. Its only stable ...
,
potassium Potassium is the chemical element with the symbol K (from Neo-Latin '' kalium'') and atomic number19. Potassium is a silvery-white metal that is soft enough to be cut with a knife with little force. Potassium metal reacts rapidly with atmosp ...
or
calcium Calcium is a chemical element with the symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar t ...
. 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.


Overview


Anions and cations

Calcium, magnesium, potassium, and sodium ions are
cations An ion () is an atom or molecule with a net electrical charge. The charge of an electron is considered to be negative by convention and this charge is equal and opposite to the charge of a proton, which is considered to be positive by conve ...
(+), while chloride, and phosphate ions are
anions An ion () is an atom or molecule with a net electrical charge. The charge of an electron is considered to be negative by convention and this charge is equal and opposite to the charge of a proton, which is considered to be positive by conve ...
(−).


Causes

Chronic
laxative Laxatives, purgatives, or aperients are substances that loosen stools and increase bowel movements. They are used to treat and prevent constipation. Laxatives vary as to how they work and the side effects they may have. Certain stimulant, lub ...
abuse or severe
diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin ...
or
vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteri ...
can lead to
dehydration In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mi ...
and electrolyte imbalance.


Malnutrition

People with
malnutrition Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues ...
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 Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults ...
,
brain herniation Brain herniation is a potentially deadly side effect of very high pressure within the skull that occurs when a part of the brain The brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrat ...
, or refeeding syndrome depending on the cause of imbalance.


General function

Electrolytes are important because they are what cells (especially
nerve A nerve is an enclosed, cable-like bundle of nerve fibers (called axons) in the peripheral nervous system. A nerve transmits electrical impulses. It is the basic unit of the peripheral nervous system. A nerve provides a common pathway for the ...
,
heart The heart is a muscular organ found in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon diox ...
and
muscle Skeletal muscles (commonly referred to as muscles) are Organ (biology), organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other ...
cells) use to maintain voltages across their cell membranes. Electrolytes have different functions, and an important one is to carry
electrical impulses Electricity is the set of physical phenomena associated with the presence and motion of matter that has a property of electric charge. Electricity is related to magnetism, both being part of the phenomenon of electromagnetism, as described by ...
between cells.
Kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; bloo ...
s work to keep the electrolyte concentrations in blood constant despite changes in the body. For example, during heavy exercise, electrolytes are lost in
sweat Perspiration, also known as sweating, is the production of fluids secreted by the sweat glands in the skin of mammals. Two types of sweat glands can be found in humans: eccrine glands and apocrine glands. The eccrine sweat glands are dist ...
, particularly in the form of sodium and potassium. The kidneys can also generate dilute urine to balance sodium levels. These electrolytes must be replaced to keep the electrolyte concentrations of the body fluids constant. Hyponatremia, or low sodium, is the most commonly seen type of electrolyte imbalance. Treatment of electrolyte imbalance depends on the specific electrolyte involved and whether the levels are too high or too low. The level of aggressiveness of treatment and choice of treatment may change depending on the severity of the disturbance. If the levels of an electrolyte are too low, a common response to electrolyte imbalance may be to prescribe supplementation. However, if the electrolyte involved is sodium, the issue is often water excess rather than sodium deficiency. Supplementation for these people may correct the electrolyte imbalance but at the expense of volume overload. For newborn children, this has serious risks. Because each individual electrolyte affects physiological function differently, they must be considered separately when discussing causes, treatment, and complications.


Calcium

Though calcium is the most plentiful electrolyte in the body, a large percentage of it is used to form the bones. It is mainly absorbed and excreted through the GI system. The majority of calcium resides extracellularly, and it is crucial for the function of
neuron A neuron, neurone, or nerve cell is an membrane potential#Cell excitability, electrically excitable cell (biology), cell that communicates with other cells via specialized connections called synapses. The neuron is the main component of nervous ...
s, muscle cells, function of
enzyme Enzymes () are proteins that act as biological catalysts by accelerating chemical reactions. The molecules upon which enzymes may act are called substrate (chemistry), substrates, and the enzyme converts the substrates into different molecule ...
s, and
coagulation Coagulation, also known as clotting, is the process by which blood changes from a liquid to a gel, forming a blood clot. It potentially results in hemostasis, the cessation of blood loss from a damaged vessel, followed by repair. The mechanis ...
. The normal range for calcium concentration in the body is 8.5 - 10.5 mg/dL. The
parathyroid gland Parathyroid glands are small endocrine glands in the neck of humans and other tetrapods. Humans usually have four parathyroid glands, located on the back of the thyroid gland in variable locations. The parathyroid gland produces and secretes ...
is responsible for sensing changes in calcium concentration and regulating the electrolyte with
parathyroid hormone Parathyroid hormone (PTH), also called parathormone or parathyrin, is a peptide hormone secreted by the parathyroid glands that regulates the serum calcium concentration through its effects on bone, kidney, and intestine. PTH influences bone r ...
.


Hypercalcemia

Hypercalcemia describes when the concentration of calcium in the blood is too high. This occurs above 10.5 mg/dL.


Causes

The most common causes of hypercalcemia are certain types of cancer,
hyperparathyroidism Hyperparathyroidism is an increase in parathyroid hormone (PTH) levels in the blood. This occurs from a disorder either within the parathyroid glands ( primary hyperparathyroidism) or as response to external stimuli (secondary hyperparathyroidis ...
,
hyperthyroidism Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormones by the thyroid gland. Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidis ...
,
pheochromocytoma Pheochromocytoma (PHEO or PCC) is a rare tumor of the adrenal medulla composed of chromaffin cells, also known as pheochromocytes. When a tumor composed of the same cells as a pheochromocytoma develops outside the adrenal gland, it is referred ...
, excessive ingestion of vitamin D,
sarcoidosis Sarcoidosis (also known as ''Besnier-Boeck-Schaumann disease'') is a disease involving abnormal collections of inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph nodes. Less commonly af ...
, and
tuberculosis Tuberculosis (TB) is an infectious disease usually caused by ''Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in w ...
. Hyperparathyroidism and malignancy are the predominant causes. It can also be caused by muscle cell breakdown, prolonged immobilization, dehydration.


Symptoms

The predominant symptoms of hypercalcemia are abdominal pain, constipation, kidney stones, extreme thirst, excessive urination, nausea and vomiting. In severe cases where the calcium concentration is >14 mg/dL, individuals may experience confusion, altered mental status, coma, and seizure.


Treatment

Primary treatment of hypercalcemia consists of administering IV fluids. If the hypercalcemia is severe and/or associated with cancer, it may be treated with bisphosphonates. For very severe cases,
hemodialysis Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of purifying the blood of a person whose kidneys are not working normally. This type of dialysis achieves the extracorporeal removal of waste products such as creatinin ...
may be considered for rapid removal of calcium from the blood.


Hypocalcemia

Hypocalcemia describes when calcium levels are too low in the blood, usually less than 8.5 mg/dL.


Causes

Hypoparathyroidism Hypoparathyroidism is decreased function of the parathyroid glands with underproduction of parathyroid hormone (PTH). This can lead to low levels of calcium in the blood, often causing cramping and twitching of muscles or tetany (involuntary mus ...
and vitamin D deficiency are common causes of
hypocalcemia Hypocalcemia is a medical condition characterized by low calcium levels in the blood serum. The normal range of blood calcium is typically between 2.1–2.6  mmol/L (8.8–10.7 mg/dL, 4.3–5.2 mEq/L) while levels less than 2.1 mm ...
. It can also be caused by
malnutrition Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues ...
, blood transfusion,
ethylene glycol Ethylene glycol ( IUPAC name: ethane-1,2-diol) is an organic compound (a vicinal diol) with the formula . It is mainly used for two purposes, as a raw material in the manufacture of polyester fibers and for antifreeze formulations. It is an od ...
intoxication, and
pancreatitis Pancreatitis is a condition characterized by inflammation of the pancreas. The pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormones. There are two main types: acute pancreatitis, and chronic p ...
.


Symptoms

Neurological and cardiovascular symptoms are the most common manifestations of hypocalcemia. Patients may experience muscle cramping or twitching, and numbness around the mouth and fingers. They may also have shortness of breath, low blood pressure, and cardiac arrhythmias.


Treatment

Patients with hypocalcemia may be treated with either oral or IV calcium. Typically, IV calcium is reserved for patients with severe hypocalcemia. It is also important to check magnesium levels in patients with hypocalcemia and to replace magnesium if it is low.


Chloride

Chloride, after sodium, is the second most abundant electrolyte in the blood, and most abundant in the
extracellular fluid In cell biology, extracellular fluid (ECF) denotes all body fluid outside the cells of any multicellular organism. Total body water in healthy adults is about 60% (range 45 to 75%) of total body weight; women and the obese typically have a lowe ...
. Most of the chloride in the body is from
salt Salt is a mineral composed primarily of sodium chloride (NaCl), a chemical compound belonging to the larger class of salts; salt in the form of a natural crystalline mineral is known as rock salt or halite. Salt is present in vast quanti ...
(NaCl) in the diet. Chloride is part of
gastric acid Gastric acid, gastric juice, or stomach acid is a digestive fluid formed within the stomach lining. With a pH between 1 and 3, gastric acid plays a key role in digestion of proteins by activating digestive enzymes, which together break down the ...
(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. Overall, treatment of chloride imbalances involve addressing the underlying cause rather than supplementing or avoiding chloride.


Hyperchloremia


Causes

Hyperchloremia, or high chloride levels, is usually associated with excess chloride intake (e.g., saltwater drowning), fluid loss (e.g., diarrhea, sweating), and metabolic acidosis.


Symptoms

Patients are usually asymptomatic with mild hyperchloremia. Symptoms associated with hyperchloremia are usually caused by the underlying cause of this electrolyte imbalance.


Treatment

Treat the underlying cause, which commonly includes increasing fluid intake.


Hypochloremia


Causes

Hypochloremia, or low chloride levels, are commonly associated with gastrointestinal (e.g., vomiting) and kidney (e.g., diuretics) losses. Greater water or sodium intake relative to chloride also can contribute to hypochloremia.


Symptoms

Patients are usually asymptomatic with mild hypochloremia. Symptoms associated with hypochloremia are usually caused by the underlying cause of this electrolyte imbalance.


Treatment

Treat the underlying cause, which commonly includes increasing fluid intake.


Magnesium

Magnesium Magnesium is a chemical element with the symbol Mg and atomic number 12. It is a shiny gray metal having a low density, low melting point and high chemical reactivity. Like the other alkaline earth metals (group 2 of the periodic ...
is mostly found in the bones and within cells. Approximately 1% of total magnesium in the body is found in the blood. Magnesium is important in control of metabolism and is involved in numerous enzyme reactions. A normal range is 0.70 - 1.10 mmol/L. The kidney is responsible for maintaining the magnesium levels in this narrow range.


Hypermagnesemia

Hypermagnesemia, or abnormally high levels of magnesium in the blood, is relatively rare in individuals with normal kidney function. 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. Most 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, or 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. The kidneys are responsible for excreting the majority of potassium from the body. This means their function is crucial for maintaining a proper balance of potassium in the blood stream.


Hyperkalemia

Hyperkalemia Hyperkalemia is an elevated level of potassium (K+) in the blood. Normal potassium levels are between 3.5 and 5.0 mmol/L (3.5 and 5.0 mEq/L) with levels above 5.5mmol/L defined as hyperkalemia. Typically hyperkalemia does not cause symptoms. Occa ...
means the concentration of potassium in the blood is too high. This occurs when the concentration of potassium is >5 mEq/L. It can lead to cardiac
arrhythmia Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults ...
s and even death. As such it is considered to be the most dangerous electrolyte disturbance.


Causes

Hyperkalemia is typically caused by decreased excretion by the kidneys, shift of potassium to the extracellular space, or increased consumption of potassium rich foods in patients with kidney failure. The most common cause of hyperkalemia is lab error due to potassium released as blood cells from the sample break down. Other common causes are kidney disease,
cell death Cell death is the event of a biological cell ceasing to carry out its functions. This may be the result of the natural process of old cells dying and being replaced by new ones, as in programmed cell death, or may result from factors such as di ...
,
acidosis Acidosis is a process causing increased acidity in the blood and other body tissues (i.e., an increase in hydrogen ion concentration). If not further qualified, it usually refers to acidity of the blood plasma. The term ''acidemia'' describes ...
, and drugs that affect kidney function.


Symptoms

Part of the danger of hyperkalemia is that it is often asymptomatic, and only detected during normal lab work done by primary care physicians. As potassium levels get higher, individuals may begin to experience nausea, vomiting, and diarrhea. Patients with severe hyperkalemia, defined by levels above 7 mEq/L, may experience muscle cramps, numbness, tingling, absence of reflexes, and paralysis. Patients may experience arrhythmias that can result in death.


Treatment

There are three mainstays of treatment of hyperkalemia. These are stabilization of cardiac cells, shift of potassium into the cells, and removal of potassium from the body. Stabilization of cardiac muscle cells is done by administering calcium intravenously. Shift of potassium into the cells is done using both insulin and albuterol inhalers. Excretion of potassium from the body is done using either
hemodialysis Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of purifying the blood of a person whose kidneys are not working normally. This type of dialysis achieves the extracorporeal removal of waste products such as creatinin ...
,
loop diuretic Loop diuretics are diuretics that act on the Na-K-Cl cotransporter along the thick ascending limb of the loop of Henle in the kidney. They are primarily used in medicine to treat hypertension and edema often due to congestive heart failure or ...
s, or a resin that causes potassium to be excreted in the fecal matter.


Hypokalemia

The most common electrolyte disturbance, hypokalemia means that the concentration of potassium is <3.5 mEq/L. It often occurs concurrently with low magnesium levels.


Causes

Low potassium is caused by increased excretion of potassium, decreased consumption of potassium rich foods, movement of potassium into the cells, or certain
endocrine disease Endocrine diseases are disorders of the endocrine system. The branch of medicine associated with endocrine disorders is known as endocrinology. Types of disease Broadly speaking, endocrine disorders may be subdivided into three groups: # Endocri ...
s. Excretion is the most common cause of hypokalemia and can be caused by diuretic use,
metabolic acidosis Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidne ...
,
diabetic ketoacidosis Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally los ...
,
hyperaldosteronism Hyperaldosteronism is a medical condition wherein too much aldosterone is produced by the adrenal glands, which can lead to lowered levels of potassium in the blood (hypokalemia) and increased hydrogen ion excretion ( alkalosis). This cause of m ...
, and
renal tubular acidosis Renal tubular acidosis (RTA) is a medical condition that involves an accumulation of acid in the body due to a failure of the kidneys to appropriately acidify the urine. In renal physiology, when blood is filtered by the kidney, the filtrate p ...
. Potassium can also be lost through vomiting and diarrhea.


Symptoms

Hypokalemia is often asymptomatic, and symptoms may not appear until potassium concentration is <2.5 mEq/L. Typical symptoms consist of muscle weakness and cramping. Low potassium can also cause cardiac arrythmias.


Treatment

Hypokalemia is treated by replacing the body's potassium. This can occur either orally or intravenously. Because low potassium is usually accompanied by low magnesium, patients are often given magnesium alongside potassium.


Sodium

Sodium is the most abundant electrolyte in the blood. 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. Because cell membranes are permeable to water but not sodium, the movement of water across membranes affects the concentration of sodium in the blood. Sodium acts as a force that pulls water across membranes, and water moves from places with lower sodium concentration to places with higher sodium concentration. This happens through a process called
osmosis Osmosis (, ) is the spontaneous net movement or diffusion of solvent molecules through a selectively-permeable membrane from a region of high water potential (region of lower solute concentration) to a region of low water potential (region of ...
. When evaluating sodium imbalances, both total body water and total body sodium must be considered.


Hypernatremia

Hypernatremia means that the concentration of sodium in the blood is too high. An individual is considered to be having high sodium at levels above 145 mEq/L of sodium. Hypernatremia is not common in individuals with no other health concerns. Most individuals with this disorder have either experienced loss of water from diarrhea, altered sense of thirst, inability to consume water, inability of kidneys to make concentrated urine, or increased salt intake.


Causes

There are three types of hypernatremia each with different causes. The first is dehydration along with low total body sodium. This is most commonly caused by heatstroke, burns, extreme sweating, vomiting, and diarrhea. The second is low total body water with normal body sodium. This can be caused by
diabetes insipidus Diabetes insipidus (DI), recently renamed to Arginine Vasopressin Deficiency (AVP-D) and Arginine Vasopressin Resistance (AVP-R), is a condition characterized by large amounts of dilute urine and increased thirst. The amount of urine produced ...
, renal disease, hypothalamic dysfunction,
sickle cell disease Sickle cell disease (SCD) is a group of blood disorders typically inherited from a person's parents. The most common type is known as sickle cell anaemia. It results in an abnormality in the oxygen-carrying protein haemoglobin found in red b ...
, and certain drugs. The third is increased total body sodium which is caused by increased ingestion,
Conn's syndrome Primary aldosteronism (PA)'','' also known as primary hyperaldosteronism or Conn's syndrome, refers to the excess production of the hormone aldosterone from the adrenal glands, resulting in low renin levels and high blood pressure. This abnormalit ...
, or
Cushing's syndrome Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to glucocorticoids such as cortisol. Signs and symptoms may include high blood pressure, abdominal obesity but with thin arms and legs, reddish stretch marks ...
.


Symptoms

Symptoms of hypernatremia may vary depending on type and how quickly the electrolyte disturbance developed. Common symptoms are dehydration, nausea, vomiting, fatigue, weakness, increased thirst, excess urination. Patients may be on medications that caused the imbalance such as
diuretic A diuretic () is any substance that promotes diuresis, the increased production of urine. This includes forced diuresis. A diuretic tablet is sometimes colloquially called a water tablet. There are several categories of diuretics. All diuretics in ...
s or
nonsteroidal anti-inflammatory drug Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...
s. Some patients may have no obvious symptoms at all.


Treatment

It is crucial to first assess the stability of the patient. If there are any signs of shock such as
tachycardia Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal ( ...
or
hypotension Hypotension is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. Blood pressure is indicated by two numbers, the systolic blood pressure (the top number) and the dia ...
, these must be treated immediately with IV saline infusion.  Once the patient is stable, it is important to identify the underlying cause of hypernatremia as that may affect the treatment plan. The final step in treatment is to calculate the patients free water deficit, and to replace it at a steady rate using a combination of oral or IV fluids.  The rate of replacement of fluids varies depending on how long the patient has been hypernatremic. Lowering the sodium level too quickly can cause cerebral edema.


Hyponatremia

Hyponatremia means that the concentration of sodium in the blood is too low. It is generally defined as a concentration lower than 135 mEq/L. This relatively common electrolyte disorder can indicate the presence of a disease process, but in the hospital setting is more often due to administration of
Hypotonic In chemical biology, tonicity is a measure of the effective osmotic pressure gradient; the water potential of two solutions separated by a partially-permeable cell membrane. Tonicity depends on the relative concentration of selective membrane-i ...
fluids. The majority of hospitalized patients only experience mild hyponatremia, with levels above 130 mEq/L. Only 1-4% of patients experience levels lower than 130 mEq/L.


Causes

Hyponatremia has many causes including
heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, ...
,
chronic kidney disease Chronic kidney disease (CKD) is a type of kidney disease in which a gradual loss of kidney function occurs over a period of months to years. Initially generally no symptoms are seen, but later symptoms may include leg swelling, feeling tired, ...
,
liver disease Liver disease, or hepatic disease, is any of many diseases of the liver. If long-lasting it is termed chronic liver disease. Although the diseases differ in detail, liver diseases often have features in common. Signs and symptoms Some of the s ...
, treatment with
thiazide Thiazide () refers to both a class of sulfur-containing organic molecules and a class of diuretics based on the chemical structure of benzothiadiazine. The thiazide drug class was discovered and developed at Merck and Co. in the 1950s. The fir ...
diuretics, psychogenic polydipsia,
syndrome of inappropriate antidiuretic hormone secretion Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by excessive unsuppressible release of antidiuretic hormone (ADH) either from the posterior pituitary gland, or an abnormal non-pituitary source. Unsuppressed ADH ca ...
. It can also be found in the postoperative state, and in the setting of accidental water intoxication as can be seen with intense exercise. Common causes in pediatric patients may be diarrheal illness, frequent feedings with dilute formula, water intoxication via excessive consumption, and
enema An enema, also known as a clyster, is an injection of fluid into the lower bowel by way of the rectum.Cullingworth, ''A Manual of Nursing, Medical and Surgical'':155 The word enema can also refer to the liquid injected, as well as to a devic ...
s.
Pseudohyponatremia Isotonic hyponatremia is a form of hyponatremia with mOsm measured between 280 and 295. It can be associated with pseudohyponatremia, or with isotonic infusion of glucose or mannitol. Pseudohyponatremia Certain conditions, such as extraordinar ...
is a false low sodium reading that can be caused by high levels of fats or proteins in the blood. Dilutional hyponatremia can happen in diabetics as high glucose levels pull water into the blood stream causing the sodium concentration to be lower. Diagnosis of the cause of hyponatremia relies on three factors: volume status, plasma osmolality, urine sodium levels and urine osmolality.


Symptoms

Many individuals with mild hyponatremia will not experience symptoms. Severity of symptoms is directly correlated with severity of hyponatremia and rapidness of onset. General symptoms include loss of appetite, nausea, vomiting, confusion, agitation, and weakness. More concerning symptoms involve the
central nervous system The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain and spinal cord. The CNS is so named because the brain integrates the received information and coordinates and influences the activity of all p ...
and include seizures, coma, and death due to
brain herniation Brain herniation is a potentially deadly side effect of very high pressure within the skull that occurs when a part of the brain The brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrat ...
. These usually do not occur until sodium levels fall below 120 mEq/L.


Treatment

Considerations for treatment include symptom severity, time to onset, volume status, underlying cause, and sodium levels. If the sodium level is <120 mEq/L, the person can be treated with
hypertonic In chemical biology, tonicity is a measure of the effective osmotic pressure gradient; the water potential of two solutions separated by a partially-permeable cell membrane. Tonicity depends on the relative concentration of selective membrane- ...
saline as extremely low levels are associated with severe neurological symptoms. In non-emergent situations, it is important to correct the sodium slowly to minimize risk of osmotic demyelination syndrome. If a person has low total body water and low sodium they are typically given fluids. If a person has high total body water (such as due to
heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, ...
or kidney disease) they may be placed on fluid restriction, salt restriction, and treated with a
diuretic A diuretic () is any substance that promotes diuresis, the increased production of urine. This includes forced diuresis. A diuretic tablet is sometimes colloquially called a water tablet. There are several categories of diuretics. All diuretics in ...
. If a person has a normal volume of total body water, they may be placed on fluid restriction alone.


Dietary sources

Diet significantly contributes to electrolyte stores and blood levels. Below are a list of foods that are associated with higher levels of these electrolytes.


Sodium

It is recommended that an individual consumes less than 2,300 mg of sodium daily as part of a healthy diet. A significant portion of our sodium intake comes from a just a few types of food, which can be surprising as large sources of sodium may not taste salty. * Breads * Soups * Cured meats and cold cuts * Cheese * Savory snacks (e.g., chips, crackers, pretzels)


Phosphate

In minerals,
phosphorus Phosphorus is a chemical element with the symbol P and atomic number 15. Elemental phosphorus exists in two major forms, white phosphorus and red phosphorus, but because it is highly reactive, phosphorus is never found as a free element on Ea ...
generally occurs as phosphate. Good sources of phosphorus includes
baking powder Baking powder is a dry chemical leavening agent, a mixture of a carbonate or bicarbonate and a weak acid. The base and acid are prevented from reacting prematurely by the inclusion of a buffer such as cornstarch. Baking powder is used to incre ...
, instant pudding, cottonseed meal, hemp seeds, fortified beverages, dried whey.


Potassium

Good sources of potassium are found in a variety of fruits and vegetables. Recommend potassium intake for adults ranges from 2,300 mg to 3,400 mg depending on age and gender. * Beans and lentils * Dark leafy greens (e.g., spinach, kale) * Apples * Apricots * Potatoes * Squash * Bananas * Dates


Calcium

Dairy is a major contributor of calcium to diet in the United States. The recommended calcium intake for adults range from 1,000 mg to 1,300 mg depending on age and gender. * Yogurt * Cheese * Milk * Tofu * Canned sardines


Magnesium

Magnesium is found in a variety of vegetables, meats, and grains. Foods high in fiber generally are a source of magnesium. The recommended magnesium intake for adults range from 360 mg to 420 mg depending on age and gender. * Epsom salt * Nuts and seeds (e.g., pumpkin seeds, almonds, peanuts) * Dark leafy greens (e.g., spinach) * Beans * Fortified cereals


See also

*
Acidosis Acidosis is a process causing increased acidity in the blood and other body tissues (i.e., an increase in hydrogen ion concentration). If not further qualified, it usually refers to acidity of the blood plasma. The term ''acidemia'' describes ...
* Alkalosis *
Dehydration In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mi ...
*
Malnutrition Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues ...
*
Starvation Starvation is a severe deficiency in caloric energy intake, below the level needed to maintain an organism's life. It is the most extreme form of malnutrition. In humans, prolonged starvation can cause permanent organ damage and eventually, dea ...
*
Sports drink Sports drinks, also known as electrolyte drinks, are functional beverages whose stated purpose is to help athletes replace water, electrolytes, and energy before, during and especially after training or competition. There are many perceived be ...


References


External links

* {{DEFAULTSORT:Water-electrolyte imbalance * Causes of death