Understanding Electrolyte Imbalances: Causes, Symptoms, and Prevention
Electrolytes are minerals that are essential for many bodily functions, including regulating fluid balance, maintaining nerve and muscle function, and controlling blood pressure. Abnormal electrolyte findings can be caused by a variety of factors, including dehydration, vomiting, diarrhea, excessive sweating, kidney disease, and certain medications.
Hyponatremia (low sodium) can cause symptoms such as headache, nausea, vomiting, muscle cramps, confusion, and seizures. It can be caused by dehydration, excessive water intake, or use of diuretics.
Hypernatremia (high sodium) can cause symptoms such as thirst, restlessness, dry skin and mucous membranes, muscle weakness, seizures, and coma. It can be caused by loss of fluids through diarrhea, vomiting, or sweating, or by excessive salt intake.
Hypokalemia (low potassium) can cause symptoms such as muscle weakness, cramps, paralysis, and arrhythmias. It can be caused by excessive loss through vomiting, diarrhea, or urination, or by use of certain medications.
Hyperkalemia (high potassium) can cause symptoms such as arrhythmias, muscle weakness, paralysis, and respiratory arrest. It can be caused by kidney disease, use of certain medications, or a condition where potassium moves out of tissue cells into plasma.
Hypomagnesemia (low magnesium) can cause symptoms such as muscle cramps, tremors, tetany, seizures, and arrhythmias. It can be caused by excessive loss through the GI tract, use of certain medications, or chronic alcoholism.
Hypermagnesemia (high magnesium) can cause symptoms such as muscle weakness, lethargy, confusion, and coma. It is most commonly caused by renal disease and renal failure.
| Electrolyte | Normal adult range | Deficiency | Excess |
|---|---|---|---|
| Calcium | 4.5-5.5 mEq/L | Hypoparathyroidism, acute pancreatitis, hyperphosphatemia, thyroid carcinoma, vitamin D deficiency | Prolonged immobilization, hyperparathyroidism, malignancy of bone |
| Potassium | 3.5-5 mEq/L | Excessive loss through vomiting, urination, perspiration, or diarrhea; renal failure; hyporaldosteronism; use of drugs | Use of drugs, poor intake of potassium, excessive intake of potassium, hyperaldosteronism, condition where potassium moves out of tissue cells into plasma |
| Sodium | 135-145 mEq/L | Excessive loss through diarrhea, sweating, vomiting, or use of diuretics; excessive water intake; head injury | Loss of fluids through diarrhea; deprivation of water; excessive salt intake; diabetes insipidus; heat stroke |
| Chloride | 95-108 mEq/L | Addison’s disease, diarrhea, metabolic alkalosis, respiratory acidosis, vomiting | Cardiac decompensation, metabolic acidosis, respiratory alkalosis, corticosteroid therapy, uremia |
| Magnesium | 1.5-2.5 mEq/L | Excessive loss from GI tract, use of drugs, chronic alcoholism, diabetic ketoacidosis, hyperparathyroidism | Renal disease and renal failure, treatment with magnesium and magnesium-containing medications |
| Phosphate | 2.5-4.5 mEq/L | Alkalosis, diabetes, chronic alcoholism, recovery from malnutrition, severe diarrhea | Renal failure, hypoparathyroidism, excessive ingestion of phosphorus, trauma, heat stroke |
IV fluids used to correct electrolyte imbalances:
| Electrolyte imbalance | IV fluid |
|---|---|
| Hyponatremia | Isotonic saline (0.9% NaCl) |
| Hypernatremia | Dextrose 5% in water (D5W) |
| Hypokalemia | Potassium chloride (KCl) |
| Hyperkalemia | Dextrose 10% in water (D10W) with insulin |
| Hypochloremia | Isotonic saline (0.9% NaCl) |
| Hyperchloremia | Dextrose 5% in water (D5W) |
| Metabolic acidosis | Sodium bicarbonate (NaHCO3) |
| Metabolic alkalosis | Normal saline (0.9% NaCl) |
| Hypomagnesemia | Magnesium sulfate (MgSO4) |
| Hypermagnesemia | Calcium gluconate (Ca gluconate) |
| Hypocalcemia | Calcium gluconate (Ca gluconate) |
| Hypercalcemia | Normal saline (0.9% NaCl) |
| Hypophosphatemia | Potassium phosphate (KPO4) |
| Hyperphosphatemia | Dextrose 5% in water (D5W) with insulin |
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