Electrolyte disturbance

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Electrolyte Disturbance Main Page

Patient Information

Overview

Classification

Hyponatremia
Hypernatremia
Hypokalemia
Hyperkalemia
Hypocalcemia
Hypercalcemia
Hypophosphatemia
Hyperphosphatemia
Hypomagnesemia
Hypermagnesemia

Causes

Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Synonyms and keywords: abnormal electrolytes, abnormal lytes, lytes

Overview

Electrolytes are electrically charged solutes necessary to maintain body homeostasis. The main electrolytes include Sodium (Na), Potassium (K), Chloride (Cl), Calcium (Ca), Phosphorus (P), and Magnesium (Mg). These electrolytes are involved in multiple physiologic and neurohormonal reactions necessary to maintain neuromuscular, neuronal, myocardial, and acid-base balance. Their balance are mainly regulated by renal and endocrine systems, any changes in their balance may be life threatening. Electrolytes are in balance to achieve neutral electrical charges. Electrolytes could be classified based on their electrical charge to anions and cations. Anions include bicarbonate, chloride, and phosphorus. Cations are calcium, magnesium, potassium, and sodium. Sodium and chloride are the major extracellular ions that has the greatest impact on serum osmolality (solute concentration in 1 liter of water). Calcium and bicarbonate are the other major extracellular electrolytes. Main intracellular electrolytes are potassium, phosphorus, and magnesium.

Causes

The following table summarize the common causes for electrolytes imbalance.

Electrolyte Ionic formula Normal limits (meq/l) Disturbance Lab value Common causes
Sodium Na+ 135-145 Hyponatremia <135 meq/L Hypovolemic[1]
Euvolemic[2][3][4] SIADH, glucocorticoid deficiency, psychogenic polydipsia
Hypervolemic[5][6][7] CHF, cirrhosis, nephrotic syndrome, renal failure
Hypernatremia >145 meq/L Extrarenal loss[8][9] Vomiting, diarrhea, insensible loss
Renal loss[10] Diuretics, diabetes insipidus (central and nephrogenic)
Potassium K+ 3.5-5 Hypokalemia <3.5 meq/L Transcellular shifts[11][12] Insulin therapy, alkalosis
GI loss[13][14] Diarrhea, laxative abuse, vomiting
Renal loss[15][16][17][18]
Hyperkalemia[19][20][21] >5 meq/L ACE inhibitors, acidosis, addisonian crisis, beta blockers, blood transfusion, cirrhosis, diabetic nephropathy, high potassium diet, malnutrition, renal tubular acidosis type IV, renal failure
Calcium Ca2+ 8.5-10.2 Hypocalcemia[22][23][24] <8.5 meq/L Hypoparathyroidism, pseudohypoparathyroidism, hypomagnesemia, hypovitaminosis D,

chronic kidney disease, hypoalbuminemia

Hypercalcemia[25][26][27][28] >10.2 meq/L Hyperparathyroidism, familial hypocalciuric hypercalcemia, malignancy, Milk-alkali syndrome,

vitamin D toxicity, sarcoidosis, diuretics, lithium

Phosphate PO43- 2.5-4.5 Hypophosphatemia[29][30][31] <2.5 meq/L Refeeding syndrome, respiratory alkalosis, alcohol abuse, malabsorption
Hyperphosphatemia[32][33] >4.5 meq/L Transcellular shift, tumor lysis syndrome , rhabdomyolysis, hypoparathyroidism, pseudohypoparathyroidism, acute kidney injury, chronic kidney disease
Magnesium Mg2+ 1.5-2.5 Hypomagnesemia[34][35][36] <1.5 meq/L Alcohol use, uncontrolled diabetes mellitus, hypercalcemia, Gitelman syndrome, loop and thiazide diuretics
Hypermagnesemia[37][38] >2.5 meq/L Renal failure, massive oral ingestion

Diagnosis

Diagnosis of electrolyte disturbances is suspected by clinical presentation and will be confirmed by laboratory values. Clinical manifestations depends on the severity of disturbances and their chronicity however, the presentation may vary according to underlying condition. The following table summarize common symptoms and signs of electrolytes disturbances and important ECG findings.

Disturbance Chronicity/ Level (meq/L) Common clinical manifestations ECG findings
Symptoms Signs
Hyponatremia Early/125-130 Nausea, malaise Muscle cramps N/A
Late/115-120 Headache, lethargy respiratory distress, coma, seizure Non specific St-T changes
Hypernatremia >145 Malaise Lethargy, confusion, coma Non specific St-T changes
Hypokalemia[39] <2.5-3 Nausea, anorexia,vomiting, muscle weakness, muscle cramps Rhabdomyolysis, respiratory failure
  • ECG changes: ST depression, decrease in T wave amplitude, U wave, QT prolongation
  • Arrhythmia: PAC, PVC, sinus bradycardia, paroxysmal atrial or junctional tachycardia, atrioventricular block, and ventricular tachycardia or fibrillation
Hyperkalemia
Hypocalcemia
Hypercalcemia
Hypophosphatemia
Hyperphosphatemia
Hypomagnesemia
Hypermagnesemia

References

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  2. ↑ Pham PC, Pham PM, Pham PT (May 2006). "Vasopressin excess and hyponatremia". Am. J. Kidney Dis. 47 (5): 727–37. doi:10.1053/j.ajkd.2006.01.020. PMID 16632011.
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  16. ↑ Vallon V, Schroth J, Lang F, Kuhl D, Uchida S (September 2009). "Expression and phosphorylation of the Na+-Cl- cotransporter NCC in vivo is regulated by dietary salt, potassium, and SGK1". Am. J. Physiol. Renal Physiol. 297 (3): F704–12. doi:10.1152/ajprenal.00030.2009. PMC 2739704. PMID 19570885.
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  29. ↑ Marinella MA (2005). "Refeeding syndrome and hypophosphatemia". J Intensive Care Med. 20 (3): 155–9. doi:10.1177/0885066605275326. PMID 15888903.
  30. ↑ MOSTELLAR ME, TUTTLE EP (January 1964). "EFFECTS OF ALKALOSIS ON PLASMA CONCENTRATION AND URINARY EXCRETION OF INORGANIC PHOSPHATE IN MAN". J. Clin. Invest. 43: 138–49. doi:10.1172/JCI104888. PMC 289504. PMID 14105225.
  31. ↑ Murer H, Lötscher M, Kaissling B, Levi M, Kempson SA, Biber J (June 1996). "Renal brush border membrane Na/Pi-cotransport: molecular aspects in PTH-dependent and dietary regulation". Kidney Int. 49 (6): 1769–73. PMID 8743494.
  32. ↑ Tsokos GC, Balow JE, Spiegel RJ, Magrath IT (May 1981). "Renal and metabolic complications of undifferentiated and lymphoblastic lymphomas". Medicine (Baltimore). 60 (3): 218–29. PMID 6894477.
  33. ↑ Grossman RA, Hamilton RW, Morse BM, Penn AS, Goldberg M (October 1974). "Nontraumatic rhabdomyolysis and acute renal failure". N. Engl. J. Med. 291 (16): 807–11. doi:10.1056/NEJM197410172911601. PMID 4423658.
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  35. ↑ Elisaf M, Merkouropoulos M, Tsianos EV, Siamopoulos KC (December 1995). "Pathogenetic mechanisms of hypomagnesemia in alcoholic patients". J Trace Elem Med Biol. 9 (4): 210–4. doi:10.1016/S0946-672X(11)80026-X. PMID 8808192.
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  37. ↑ RANDALL RE, COHEN MD, SPRAY CC, ROSSMEISL EC (July 1964). "HYPERMAGNESEMIA IN RENAL FAILURE. ETIOLOGY AND TOXIC MANIFESTATIONS". Ann. Intern. Med. 61: 73–88. PMID 14178364.
  38. ↑ Clark BA, Brown RS (1992). "Unsuspected morbid hypermagnesemia in elderly patients". Am. J. Nephrol. 12 (5): 336–43. doi:10.1159/000168469. PMID 1489003.
  39. ↑ Knochel JP, Schlein EM (July 1972). "On the mechanism of rhabdomyolysis in potassium depletion". J. Clin. Invest. 51 (7): 1750–8. doi:10.1172/JCI106976. PMC 292322. PMID 5032523.

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