{{Short description|Abnormality in the concentration of electrolytes in the body}}{{Main|Electrolyte}} {{Infobox medical condition (new) | name = Water–electrolyte imbalance | image = Membrane potential ions en.svg | caption = Diagram of [[ion]] concentrations and charge across a [[semi-permeable]] [[cellular membrane]]. | pronounce = | field = | synonyms = | symptoms = | complications = | onset = | duration = | types = | causes =hypocalcemia | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} '''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.{{Citation needed|date=May 2026}} 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 homeostasis|acid–base balance]] for example.{{Citation needed|date=May 2026}} Electrolyte imbalances can develop by consuming too little or too much electrolyte as well as [[excreting]] too little or too much electrolyte.{{cn|date=June 2022}} Examples of electrolytes include calcium, chloride, magnesium, phosphate, sodium, and potassium. Electrolytes levels in the blood (used to calculate the [[anion gap]])<ref>{{Cite journal |last1=Sagar |first1=Nandhini |last2=Lohiya |first2=Sham |date=March 2024 |title=A Comprehensive Review of Chloride Management in Critically Ill Patients |journal=Cureus |volume=16 |issue=3 |article-number=e55625 |doi=10.7759/cureus.55625 |doi-access=free |issn=2168-8184 |pmc=10995984 |pmid=38586759}}</ref> are Chloride (as Cl-)<ref name=":9">{{Cite journal |last1=Raut |first1=Satish K. |last2=Singh |first2=Kulwinder |last3=Sanghvi |first3=Shridhar |last4=Loyo-Celis |first4=Veronica |last5=Varghese |first5=Liyah |last6=Singh |first6=Ekam R. |last7=Gururaja Rao |first7=Shubha |last8=Singh |first8=Harpreet |date=2024-05-29 |title=Chloride ions in health and disease |journal=Bioscience Reports |volume=44 |issue=5 |article-number=BSR20240029 |doi=10.1042/BSR20240029 |issn=1573-4935 |pmc=11065649 |pmid=38573803}}</ref> + bicarbonate (HCO3-, used as a buffer to control the amount of Co2 in the blood)<ref>{{Cite web |title=Bicarbonate (Total Co2) |url=https://www.testing.com/tests/bicarbonate-total-co2/ |quote=This test measures the total amount of carbon dioxide (CO2) in the blood, which occurs mostly in the form of HCO3–.}}</ref> - Sodium (Na+) + Potassium (K+).<ref name=":9" />
If electrolyte concentrations are abnormal in the [[Human body|body]] (such as by overloading it with electrolytes, or the body being unable to maintain homeostasis), [[signs and symptoms]] can arise, such as those related to disease, disorders or syndromes. Electrolyte disturbances are involved in many disease processes and are an important part of patient management in medicine.<ref>{{Cite journal |last1=Alfarouk |first1=Khalid O. |last2=Ahmed |first2=Samrein B. M. |last3=Ahmed |first3=Ahmed |last4=Elliott |first4=Robert L. |last5=Ibrahim |first5=Muntaser E. |last6=Ali |first6=Heyam S. |last7=Wales |first7=Christian C. |last8=Nourwali |first8=Ibrahim |last9=Aljarbou |first9=Ahmed N. |last10=Bashir |first10=Adil H. H. |last11=Alhoufie |first11=Sari T. S. |last12=Alqahtani |first12=Saad Saeed |last13=Cardone |first13=Rosa A. |last14=Fais |first14=Stefano |last15=Harguindey |first15=Salvador |display-authors=3 |date=7 April 2020 |title=The Interplay of Dysregulated pH and Electrolyte Imbalance in Cancer |journal=Cancers |volume=12 |issue=4 |page=898 |doi=10.3390/cancers12040898 |pmc=7226178 |pmid=32272658 |doi-access=free |last16=Reshkin |first16=Stephan J. |bibcode=2020Cance..12..898A }}</ref><ref name=":0">{{Cite journal |last1=Balcı |first1=Arif Kadri |last2=Koksal |first2=Ozlem |last3=Kose |first3=Ataman |last4=Armagan |first4=Erol |last5=Ozdemir |first5=Fatma |last6=Inal |first6=Taylan |last7=Oner |first7=Nuran |date=2013 |title=General characteristics of patients with electrolyte imbalance admitted to emergency department |journal=World Journal of Emergency Medicine |volume=4 |issue=2 |pages=113–116 |doi=10.5847/wjem.j.issn.1920-8642.2013.02.005 |issn=1920-8642 |pmc=4129840 |pmid=25215103}}</ref> The causes, severity, treatment, and outcomes of these disturbances can differ greatly depending on the implicated electrolyte.<ref name=":12">{{Cite book |last1=Walls |first1=Ron M. |title=Rosen's Emergency Medicine: Concepts and Clinical Practice |last2=Hockberger |first2=Robert S. |last3=Gausche-Hill |first3=Marianne |publisher=Elsevier |year=2018 |isbn=978-0-323-35479-0 |location=Philadelphia, PA |pages=1516–1532}}</ref> 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.<ref name=":0" />
== Causes == Chronic [[laxative]] abuse or severe [[diarrhea]] or [[vomiting]] can lead to [[dehydration]] and electrolyte imbalance.<ref>{{Citation |last1=Castro |first1=Danny |title=Hypokalemia |date=2024 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK482465/ |access-date=2024-11-22 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29494072 |last2=Sharma |first2=Sandeep}}</ref><ref>{{Citation |last1=Rondon |first1=Helbert |title=Hyponatremia |date=2024 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK470386/ |access-date=2024-11-22 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29262111 |last2=Badireddy |first2=Madhu}}</ref>
====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.<ref name="Bockenhauer2014">{{Cite journal |last1=Bockenhauer |first1=D |last2=Zieg |first2=J |date=September 2014 |title=Electrolyte disorders. |journal=Clinics in Perinatology |volume=41 |issue=3 |pages=575–90 |doi=10.1016/j.clp.2014.05.007 |pmid=25155728}}</ref><ref>{{Cite journal |last1=Tisdall |first1=M |last2=Crocker |first2=M |last3=Watkiss |first3=J |last4=Smith |first4=M |date=January 2006 |title=Disturbances of sodium in critically ill adult neurologic patients: a clinical review. |journal=Journal of Neurosurgical Anesthesiology |volume=18 |issue=1 |pages=57–63 |doi=10.1097/01.ana.0000191280.05170.0f |pmc=1513666 |pmid=16369141}}</ref><ref name="Moritz2002">{{Cite journal |last1=Moritz |first1=ML |last2=Ayus |first2=JC |date=November 2002 |title=Disorders of water metabolism in children: hyponatremia and hypernatremia. |journal=Pediatrics in Review |volume=23 |issue=11 |pages=371–80 |doi=10.1542/pir.23-11-371 |pmid=12415016 |s2cid=40511233}}</ref> Restrictive eating disorders such as [[anorexia nervosa]] and [[atypical anorexia nervosa]] are also associated with electrolyte imbalance.<ref>{{Cite journal |last1=Vo |first1=Megen |last2=Golden |first2=Neville |date=2022-12-16 |title=Medical complications and management of atypical anorexia nervosa |journal=Journal of Eating Disorders |language=en |volume=10 |issue=1 |article-number=196 |doi=10.1186/s40337-022-00720-9 |doi-access=free |pmid=36522787 |issn=2050-2974|pmc=9756584 }}</ref>
== General function of electrolytes == Electrolytes are important because they are what cells (especially [[Nerve cell|nerve]], [[Cardiac muscle cell|heart]] and [[Muscle cell|muscle]] cells) use to maintain [[action potential|voltages across their cell membranes]]. Electrolytes have different functions, and an important one is to carry [[Action potential|electrical impulses]] between cells.<ref>{{Citation |last1=Barrett |first1=Kim E. |title=Excitable Tissue: Nerve |date=2019 |work=Ganong's Review of Medical Physiology |url=https://accessmedicine.mhmedical.com/content.aspx?bookid=2525§ionid=204290778 |access-date=2024-11-22 |edition=26 |place=New York, NY |publisher=McGraw-Hill Education |last2=Barman |first2=Susan M. |last3=Brooks |first3=Heddwen L. |last4=Yuan |first4=Jason X.-J.}}</ref><ref>{{Citation |last1=Barrett |first1=Kim E. |title=Central & Peripheral Neurophysiology: Introduction |date=2019 |work=Ganong's Review of Medical Physiology |url=https://accessmedicine.mhmedical.com/content.aspx?bookid=2525§ionid=204292607 |access-date=2024-11-22 |edition=26 |place=New York, NY |publisher=McGraw-Hill Education |last2=Barman |first2=Susan M. |last3=Brooks |first3=Heddwen L. |last4=Yuan |first4=Jason X.-J.}}</ref><ref>{{Citation |last1=Barrett |first1=Kim E. |title=Excitable Tissue: Muscle |date=2019 |work=Ganong's Review of Medical Physiology |url=https://accessmedicine.mhmedical.com/content.aspx?bookid=2525§ionid=204290851 |access-date=2024-11-22 |edition=26 |place=New York, NY |publisher=McGraw-Hill Education |last2=Barman |first2=Susan M. |last3=Brooks |first3=Heddwen L. |last4=Yuan |first4=Jason X.-J.}}</ref> [[Kidney]]s work to keep the electrolyte concentrations in blood constant despite changes in the body.<ref name="Bockenhauer2014" /><ref name="Moritz2002" /> For example, during heavy exercise, electrolytes are lost in [[sweat]], particularly in the form of sodium and potassium.<ref name="Moritz2002" /> The kidneys can also generate dilute urine to balance sodium levels.<ref name="Moritz2002" /> 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.<ref name="Din2017">{{Cite journal |last1=Dineen |first1=R |last2=Thompson |first2=CJ |last3=Sherlock |first3=M |date=June 2017 |title=Hyponatraemia – presentations and management. |journal=Clinical Medicine |volume=17 |issue=3 |pages=263–69 |doi=10.7861/clinmedicine.17-3-263 |pmc=6297575 |pmid=28572229}}</ref><ref>{{Cite journal |last1=Ályarez L |first1=E |last2=González C |first2=E |date=June 2014 |title=[Pathophysiology of sodium disorders in children]. |journal=Revista chilena de pediatria |type=Review |volume=85 |issue=3 |pages=269–80 |doi=10.4067/S0370-41062014000300002 |pmid=25697243 |doi-access=free}}</ref>
Treatment of electrolyte imbalance depends on the specific electrolyte involved and whether the levels are too high or too low.<ref name=":12" /> The level of aggressiveness of treatment and choice of treatment may change depending on the severity of the disturbance.<ref name=":12" /> 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.<ref name="Bockenhauer2014" />
=== Electrolytes and their imbalances ===
==== Calcium ==== Though calcium is the most plentiful electrolyte in the body, a large percentage of it is used to form the bones.<ref name=":02" /> It is mainly absorbed and excreted through the GI system.<ref name=":02" /> The majority of calcium resides extracellularly, and it is crucial for the function of [[neuron]]s, [[Myocyte|muscle cells]], function of [[enzyme]]s, and [[coagulation]].<ref name=":02" /> The normal range for calcium concentration in the body is 8.5 - 10.5 mg/dL.<ref>{{Citation |last=Goldstein |first=David A. |title=Serum Calcium |year=1990 |work=Clinical Methods: The History, Physical, and Laboratory Examinations |editor-last1=Walker |editor-first1=H. Kenneth |editor-last2=Hall |editor-first2=W. Dallas |editor-last3=Hurst |editor-first3=J. Willis |url=https://www.ncbi.nlm.nih.gov/books/NBK250/ |access-date=2020-03-11 |edition=3rd |publisher=Butterworths |isbn=978-0-409-90077-4 |pmid=21250094 }}</ref> The [[parathyroid gland]] is responsible for sensing changes in calcium concentration and regulating the electrolyte with [[parathyroid hormone]].<ref>{{Cite journal |last1=Bove-Fenderson |first1=Erin |last2=Mannstadt |first2=Michael |date=2018-10-01 |title=Hypocalcemic disorders |journal=Best Practice & Research Clinical Endocrinology & Metabolism |series=SI: Metabolic bone disease |language=en |volume=32 |issue=5 |pages=639–656 |doi=10.1016/j.beem.2018.05.006 |issn=1521-690X |pmid=30449546 |s2cid=53951967}}</ref>
===== Hypercalcemia ===== {{Main|Hypercalcaemia}} Hypercalcemia describes when the concentration of calcium in the blood is too high. This occurs above 10.5 mg/dL.<ref name=":12" />
====== Causes ====== The most common causes of hypercalcemia are certain types of cancer, [[hyperparathyroidism]], [[hyperthyroidism]], [[pheochromocytoma]], excessive ingestion of vitamin D, [[sarcoidosis]], and [[tuberculosis]].<ref name=":12" /> Hyperparathyroidism and malignancy are the predominant causes.<ref name=":02" /> It can also be caused by muscle cell breakdown, prolonged immobilization, dehydration.<ref name=":12" />
====== Symptoms ====== The predominant symptoms of hypercalcemia are abdominal pain, constipation, extreme thirst, excessive urination, kidney stones, nausea and vomiting.<ref name=":12" /><ref name=":02" /> In severe cases where the calcium concentration is >14 mg/dL, individuals may experience confusion, altered mental status, coma, and seizure.<ref name=":12" /><ref name=":02" />
====== Treatment ====== Primary treatment of hypercalcemia consists of administering IV fluids.<ref name=":12" /> If the hypercalcemia is severe and/or associated with cancer, it may be treated with bisphosphonates.<ref name=":12" /><ref name=":02" /> For very severe cases, [[hemodialysis]] may be considered for rapid removal of calcium from the blood.<ref name=":12" /><ref name=":02" />
===== Hypocalcemia ===== {{Main|Hypocalcaemia}}
Hypocalcemia describes when calcium levels are too low in the blood, usually less than 8.5 mg/dL.<ref>{{Citation |last1=Yu |first1=Elaine |title=Physiology, Calcium |date=2024 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK482128/ |access-date=2024-11-22 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29489276 |last2=Sharma |first2=Sandeep}}</ref>
====== Causes ====== [[Hypoparathyroidism]] and vitamin D deficiency are common causes of [[Hypocalcaemia|hypocalcemia]].<ref name=":12" /> It can also be caused by [[malnutrition]], blood transfusion, [[ethylene glycol]] intoxication, and [[pancreatitis]].<ref name=":12" />
====== Symptoms ====== Neurological and cardiovascular symptoms are the most common manifestations of hypocalcemia.<ref name=":12" /><ref name=":02" /> 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.<ref name=":12" />
====== Treatment ====== Patients with hypocalcemia may be treated with either oral or IV calcium.<ref name=":12" /> Typically, IV calcium is reserved for patients with severe hypocalcemia.<ref name=":12" /><ref name=":02" /> It is also important to check magnesium levels in patients with hypocalcemia and to replace magnesium if it is low.<ref name=":02" />
==== Chloride ==== Chloride, after sodium, is the second most abundant electrolyte in the blood and most abundant in the [[extracellular fluid]].<ref name=":5">{{Cite journal |last=Nagami |first=Glenn T. |date=2016-07-01 |title=Hyperchloremia – Why and how |journal=Nefrología |language=en |volume=36 |issue=4 |pages=347–353 |doi=10.1016/j.nefro.2016.04.001 |issn=0211-6995 |pmid=27267918 |doi-access=free}}</ref> Most of the chloride in the body is from [[salt]] (NaCl) in the diet.<ref>{{Cite journal |last=Powers |first=F. |date=September 1999 |title=The role of chloride in acid-base balance |journal=Journal of Intravenous Nursing |volume=22 |issue=5 |pages=286–291 |issn=0896-5846 |pmid=10776193}}</ref> 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.<ref name=":6">{{Cite journal |last1=Berend |first1=Kenrick |last2=van Hulsteijn |first2=Leonard Hendrik |last3=Gans |first3=Rijk O. B. |date=April 2012 |title=Chloride: the queen of electrolytes? |journal=European Journal of Internal Medicine |volume=23 |issue=3 |pages=203–211 |doi=10.1016/j.ejim.2011.11.013 |issn=1879-0828 |pmid=22385875}}</ref> Generally, chloride has an inverse relationship with bicarbonate, an electrolyte that indicates acid-base status.<ref name=":6" /> Overall, treatment of chloride imbalances involve addressing the underlying cause rather than supplementing or avoiding chloride.{{cn|date=June 2022}}
===== Hyperchloremia ===== {{Main|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.<ref name=":5" />
===== Symptoms ===== Patients are usually asymptomatic with mild hyperchloremia. Symptoms associated with hyperchloremia are usually caused by the underlying cause of this electrolyte imbalance.<ref name=":7">{{Cite web |title=Hyperchloremia (High Chloride) - Managing Side Effects - Chemocare |url=http://chemocare.com/chemotherapy/side-effects/hyperchloremia-high-chloride.aspx |archive-url=https://web.archive.org/web/20200327163200/http://chemocare.com/chemotherapy/side-effects/hyperchloremia-high-chloride.aspx |archive-date=2020-03-27 |access-date=2020-03-27 |website=chemocare.com}}</ref>
===== Treatment ===== Treat the underlying cause, which commonly includes increasing fluid intake.<ref name=":7" />
==== Hypochloremia ==== {{Main|Hypochloremia}}
===== Causes ===== Hypochloremia, or low chloride levels, are commonly associated with gastrointestinal (e.g., vomiting) and kidney (e.g., diuretics) losses.<ref name=":6" /> Greater water or sodium intake relative to chloride also can contribute to hypochloremia.<ref name=":6" />
===== Symptoms ===== Patients are usually asymptomatic with mild hypochloremia. Symptoms associated with hypochloremia are usually caused by the underlying cause of this electrolyte imbalance.<ref name=":8">{{Cite web |title=Hypochloremia (Low Chloride) - Managing Side Effects - Chemocare |url=http://chemocare.com/chemotherapy/side-effects/hypochloremia-low-chloride.aspx |access-date=2020-03-27 |website=chemocare.com}}</ref>
===== Treatment ===== Treat the underlying cause, which commonly includes increasing fluid intake.<ref name=":8" />
==== Magnesium ==== [[Magnesium]] is mostly found in the bones and within cells. Approximately 1% of total magnesium in the body is found in the blood.<ref name="Glasdam 169–193">{{Citation |last1=Glasdam |first1=Sidsel-Marie |title=Chapter Six - The Importance of Magnesium in the Human Body: A Systematic Literature Review |date=2016-01-01 |journal=Advances in Clinical Chemistry |volume=73 |pages=169–193 |editor-last=Makowski |editor-first=Gregory S. |publisher=Elsevier |language=en |doi=10.1016/bs.acc.2015.10.002 |pmid=26975973 |last2=Glasdam |first2=Stinne |last3=Peters |first3=Günther H.}}</ref> Magnesium is important in control of metabolism and is involved in numerous enzyme reactions. A normal range is 0.70 - 1.10 mmol/L.<ref name="Glasdam 169–193" /> The kidney is responsible for maintaining the magnesium levels in this narrow range.{{cn|date=January 2025}}
===== Hypermagnesemia ===== {{Main|Hypermagnesemia}} Hypermagnesemia, or abnormally high levels of magnesium in the blood, is relatively rare in individuals with normal kidney function.<ref>{{Cite journal |last=Van Laecke |first=Steven |date=2019-01-02 |title=Hypomagnesemia and hypermagnesemia |journal=Acta Clinica Belgica |language=en |volume=74 |issue=1 |pages=41–47 |doi=10.1080/17843286.2018.1516173 |issn=1784-3286 |pmid=30220246}}</ref> This is defined by a magnesium concentration >2.5 mg/dL.{{cn|date=January 2025}}
====== Causes ====== Hypermagnesemia typically occurs in individuals with abnormal kidney function. This imbalance can also occur with use of antacids or laxatives that contain magnesium. [[Iatrogenesis|Iatrogenic]] cases of hypermagnesemia can be prevented by avoiding magnesium-containing medications.{{cn|date=January 2025}}
====== 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.{{cn|date=June 2022}}
====== 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.{{cn|date=June 2022}}
===== Hypomagnesemia ===== {{Main|Magnesium deficiency}} Hypomagnesemia, or low magnesium levels in the blood, can occur in up to 12% of hospitalized patients.<ref>{{Cite journal |last1=Wong |first1=E. T. |last2=Rude |first2=R. K. |last3=Singer |first3=F. R. |last4=Shaw |first4=S. T. |date=March 1983 |title=A high prevalence of hypomagnesemia and hypermagnesemia in hospitalized patients |journal=American Journal of Clinical Pathology |volume=79 |issue=3 |pages=348–352 |doi=10.1093/ajcp/79.3.348 |issn=0002-9173 |pmid=6829504 |doi-access=free}}</ref> Symptoms or effects of hypomagnesemia can occur after relatively small deficits.{{cn|date=November 2024}}
====== 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.{{cn|date=January 2025}}
====== 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]].{{cn|date=November 2024}}
====== 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.{{cn|date=November 2024}}
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.{{cn|date=January 2025}}
==== Phosphate ====
===== Hyperphosphatemia ===== {{Main|Hyperphosphatemia}}
===== Hypophosphatemia ===== {{Main|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.<ref name=":02" /> The kidneys are responsible for excreting the majority of potassium from the body.<ref name=":02" /> This means their function is crucial for maintaining a proper balance of potassium in the blood stream.
===== Hyperkalemia ===== {{Main|Hyperkalemia}}
[[Hyperkalemia]] means the concentration of potassium in the blood is too high. This occurs when the concentration of potassium is >5 mEq/L.<ref name=":12" /><ref name=":02" /> It can lead to cardiac [[arrhythmia]]s and even death.<ref name=":12" /> As such it is considered to be the most dangerous electrolyte disturbance.<ref name=":12" />
====== 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.<ref name=":12" /> The most common cause of hyperkalemia is lab error due to potassium released as blood cells from the sample break down.<ref name=":02" /> Other common causes are kidney disease, [[cell death]], [[acidosis]], and drugs that affect kidney function.<ref name=":12" />
====== 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.<ref name=":12" /> As potassium levels get higher, individuals may begin to experience nausea, vomiting, and diarrhea.<ref name=":12" /> Patients with severe hyperkalemia, defined by levels above 7 mEq/L, may experience muscle cramps, numbness, tingling, absence of reflexes, and paralysis.<ref name=":12" /><ref name=":02" /> Patients may experience arrhythmias that can result in death.<ref name=":12" /><ref name=":02" />
====== Treatment ====== There are three mainstays of treatment of hyperkalemia. These are stabilization of [[Cardiac muscle cell|cardiac cells]], shift of potassium into the cells, and removal of potassium from the body.<ref name=":12" /><ref name=":02" /> Stabilization of cardiac muscle cells is done by administering calcium intravenously.<ref name=":12" /> Shift of potassium into the cells is done using both insulin and albuterol inhalers.<ref name=":12" /> Excretion of potassium from the body is done using either [[hemodialysis]], [[loop diuretic]]s, or a resin that causes potassium to be excreted in the fecal matter.<ref name=":12" />
===== Hypokalemia ===== {{Main|Hypokalemia}}
The most common electrolyte disturbance, hypokalemia means that the concentration of potassium is <3.5 mEq/L.<ref name=":12" /> It often occurs concurrently with low magnesium levels.<ref name=":12" />
====== 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]]s.<ref name=":12" /> Excretion is the most common cause of hypokalemia and can be caused by diuretic use, [[metabolic acidosis]], [[diabetic ketoacidosis]], [[hyperaldosteronism]], and [[renal tubular acidosis]].<ref name=":12" /> Potassium can also be lost through vomiting and diarrhea.<ref name=":02" />
====== Symptoms ====== Hypokalemia is often asymptomatic, and symptoms may not appear until potassium concentration is <2.5 mEq/L.<ref name=":02" /> Typical symptoms consist of muscle weakness and cramping. Low potassium can also cause cardiac arrhythmias.<ref name=":12" /><ref name=":02" />
====== Treatment ====== Hypokalemia is treated by replacing the body's potassium. This can occur either orally or intravenously.<ref name=":12" /><ref name=":02" /> Because low potassium is usually accompanied by low magnesium, patients are often given magnesium alongside potassium.<ref name=":02" />
==== Sodium ==== Sodium is the most abundant electrolyte in the blood.<ref>{{Citation |last1=Rn) |first1=Open Resources for Nursing (Open |title=Chapter 15 Fluids and Electrolytes |date=2021 |work=Nursing Fundamentals [Internet] |url=https://www.ncbi.nlm.nih.gov/books/NBK591820/ |access-date=2024-11-22 |publisher=Chippewa Valley Technical College |language=en |last2=Ernstmeyer |first2=Kimberly |last3=Christman |first3=Elizabeth}}</ref> 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 [[Body water|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.<ref name=":2">{{Cite book |last1=Tintinalli |first1=Judith E. |title=Tintinalli's Emergency Medicine: A Comprehensive Study Guide |last2=Stapczynski |first2=J. Stephan |last3=Ma |first3=O. John |last4=Yealy |first4=Donald M. |last5=Meckler |first5=Garth D. |last6=Cline |first6=David M. |publisher=McGraw-Hill |year=2016 |isbn=978-0-07-179476-3 |location=New York, NY}}</ref> 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.<ref name=":2" /> 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]].<ref name=":2" /> When evaluating sodium imbalances, both total body water and total body sodium must be considered.<ref name=":12" />
===== Hypernatremia ===== {{Main|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.<ref name=":12" /> 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.<ref name=":12" /><ref name=":2" />
====== Causes ====== There are three types of hypernatremia each with different causes.<ref name=":12" /> The first is dehydration along with low total body sodium. This is most commonly caused by heatstroke, burns, extreme sweating, vomiting, and diarrhea.<ref name=":12" /> The second is low total body water with normal body sodium. This can be caused by [[diabetes insipidus]], renal disease, [[hypothalamic dysfunction]], [[sickle cell disease]], and certain drugs.<ref name=":12" /> The third is increased total body sodium which is caused by increased ingestion, [[Conn's syndrome]], or [[Cushing's syndrome]].<ref name=":12" />
====== Symptoms ====== Symptoms of hypernatremia may vary depending on type and how quickly the electrolyte disturbance developed.<ref name=":2" /> Common symptoms are dehydration, nausea, vomiting, fatigue, weakness, increased thirst, and excess urination. Patients may be on medications that caused the imbalance such as [[diuretic]]s or [[nonsteroidal anti-inflammatory drug]]s.<ref name=":2" /> Some patients may have no obvious symptoms at all.<ref name=":2" />
====== Treatment ====== It is crucial to first assess the stability of the patient. If there are any signs of shock such as [[tachycardia]] or [[hypotension]], these must be treated immediately with IV saline infusion.<ref name=":12" /><ref name=":2" /> Once the patient is stable, it is important to identify the underlying cause of hypernatremia as that may affect the treatment plan.<ref name=":12" /><ref name=":2" /> 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.<ref name=":12" /><ref name=":2" /> 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.<ref name=":2" />
===== Hyponatremia ===== {{Main|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.<ref name=":12" /> 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]] fluids.<ref name=":02">{{Cite book |last1=Tintinalli |first1=JE |title=Tintinalli's Emergency Medicine: A Comprehensive Study Guide |last2=Stapczynski |first2=J |last3=Ma |first3=O |last4=Yealy |first4=DM |last5=Meckler |first5=GD |last6=Cline |first6=DM |publisher=McGraw-Hill |year=2016 |isbn=978-0-07-179476-3 |location=New York, NY}}</ref><ref name=":12" /> 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.<ref name=":02" />
====== Causes ====== Hyponatremia has many causes including [[heart failure]], [[chronic kidney disease]], [[liver disease]], treatment with [[thiazide]] diuretics, [[psychogenic polydipsia]], and [[syndrome of inappropriate antidiuretic hormone secretion]].<ref name=":12" /> It can also be found in the postoperative state, and in the setting of accidental water intoxication as can be seen with intense exercise.<ref name=":12" /> Common causes in pediatric patients may be diarrheal illness, frequent feedings with dilute formula, water intoxication via excessive consumption, and [[enema]]s.<ref name=":12" /> [[Pseudohyponatremia]] is a false low sodium reading that can be caused by high levels of fats or proteins in the blood.<ref name=":02" /><ref name=":12" /> Dilutional hyponatremia can happen in diabetics as high glucose levels pull water into the blood stream causing the sodium concentration to be lower.<ref name=":02" /><ref name=":12" /> Diagnosis of the cause of hyponatremia relies on three factors: volume status, [[plasma osmolality]], urine sodium levels and [[urine osmolality]].<ref name=":02" /><ref name=":12" />
====== Symptoms ====== Many individuals with mild hyponatremia will not experience symptoms. Severity of symptoms is directly correlated with severity of hyponatremia and rapidness of onset.<ref name=":12" /> General symptoms include loss of appetite, nausea, vomiting, confusion, agitation, and weakness.<ref name=":02" /><ref name=":12" /> More concerning symptoms involve the [[central nervous system]] and include seizures, coma, and death due to [[brain herniation]].<ref name=":02" /><ref name=":12" /> These usually do not occur until sodium levels fall below 120 mEq/L.<ref name=":12" />
====== Treatment ====== Considerations for treatment include symptom severity, time to onset, volume status, underlying cause, and sodium levels.<ref name=":02" /> If the sodium level is <120 mEq/L, the person can be treated with [[hypertonic]] saline as extremely low levels are associated with severe neurological symptoms.<ref name=":02" /> In non-emergency situations, it is important to correct the sodium slowly to minimize risk of [[osmotic demyelination]] syndrome.<ref name=":02" /><ref name=":12" /> If a person has low total body water and low sodium they are typically given fluids.<ref name=":12" /> If a person has high total body water (such as due to [[heart failure]] or kidney disease) they may be placed on fluid restriction, salt restriction, and treated with a [[diuretic]].<ref name=":12" /> If a person has a normal volume of total body water, they may be placed on fluid restriction alone.<ref name=":12" />
==See also== * [[Acidosis]] (low pH) and [[alkalosis]] (high pH) * [[Dehydration]] * [[Malnutrition]] * [[Starvation]] * [[Sports drink]]
==References== {{Reflist}}
== External links == * {{Cite journal |date=13 December 2005 |title=Part 10.1: Life-Threatening Electrolyte Abnormalities |journal=Circulation |language=en |volume=112 |issue=24_supplement |doi=10.1161/CIRCULATIONAHA.105.166563 |s2cid=79026294 |doi-access=free}} {{Medical resources | DiseasesDB = | ICD10 = {{ICD10|E|86||e|70}}-{{ICD10|E|87||e|70}} | ICD9 = {{ICD9|276}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = D014883 }} {{Electrolyte abnormalities}} {{Nutritional pathology}}
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[[Category:Electrolyte disturbances|*]] [[Category:Causes of death]]