Electrolytes Imbalance

Electrolyte imbalance happens when the concentration (amount) of electrolytes in the body is not at normal levels. Electrolytes, which are charged particles, are found in our bodies. They carry a charge which can be positive or negative and so can conduct current when dissolved in water. Just as the electric current is needed by the electrical appliances in our homes to work, the processes running in our body also need a little current to function properly. Electrolytes are crucial, whether it’s a muscle of the beating heart or a muscle of the limbs, a process of thinking, or a signal of making a protein. A strict balance of electrolytes is maintained by the homeostatic mechanisms of our body, of which kidneys play a vital role. Kidneys and electrolytes work in collaboration to regulate the homeostasis of our bodies' fluid, electrolytes, and acid-base status.

Any changes in these levels can disrupt the body processes resulting in signs and symptoms ranging from nausea, vomiting, fatigue, irritability, arrhythmias, seizures, coma, and death. 

These changes usually result from loss of fluid during strenuous exercise in the form of sweat or conditions like diarrhea and vomiting. Some other diseases, medicines, or conditions may also cause electrolyte imbalance. 

Children and older adults are the vulnerable populations to be severely affected by dehydration and electrolyte imbalances, so it should be vigilantly managed in them. 

The common electrolytes found in our body are;

• Sodium
• Potassium
• Calcium
• Magnesium
• Chloride
• Phosphate

Sodium: The normal level is 136–145 mEq/l. It is important for maintaining blood pressure, fluid levels, muscle and nerve functions. Excess of sodium is called hypernatremia, and deficiency is called hyponatremia. 

Potassium: The normal level is 3.6–5.5 mEq/l. It is important for maintaining blood pressure, heart rate, electrolytes, fluid balance, nerve and muscle contraction, and bone health. Excess of potassium is called hyperkalemia, and deficiency is called hypokalemia. 

Calcium: The normal level is 9–11 mg/dl. It is important in blood clotting, bone and teeth health, nerve and muscle contraction. Excess of calcium is called hypercalcemia, and deficiency is called hypocalcemia.

Chloride: The normal level is 96 to 106 mEq/L. It is important in maintaining pH (acidity and alkalinity ) of the body, digestion. Excess of chloride is called hyperchloremia, and deficiency is called hypochloremia.

Phosphate: The normal level is 3.4–4.5 mg/dl. It is important for strengthening bones and teeth and tissue growth and repair. Excess of phosphate is called hyperphosphatemia, and deficiency is called hypophosphatemia.

Magnesium: The normal level is 1.5–2.5 mEq/l. It is important for nerve and muscle function, heart rhythm, immune system, production of DNA and RNA, blood glucose levels. Excess of magnesium is called hypermagnesemia, and deficiency is called hypomagnesemia.

The following risk factors can put you at higher risk of getting an electrolyte imbalance;

• Not able to drink enough water
• Suffering from diseases causing vomiting and diarrhea
• Excessive sweating due to hot and humid weather or fever 
• Chronic illnesses, like diabetes, kidney disease, bowel disorders, adrenal gland disorders, celiac disease
• Excessive alcohol use 
• Eating disorders, like anorexia nervosa and bulimia nervosa
• Severe burns

Electrolyte imbalance is usually found in people working in stressful conditions like soldier’s training, wars, and patients admitted in the ICU. The US armed forces reported 7.2 cases per 100,000 person-years from 2003 through 2018 of hyponatremia. According to a review by Tsipotis et alo,  21% of the patients had community-acquired hypernatremia, while 25.9% of patients had hospital-acquired hypernatremia. Calcium imbalances are found mostly in patients with breast cancer, lung cancer, and multiple myeloma due to bone destruction. Hypokalemia frequency is 1% in the US, while hyperkalemia is found rarely in the general population and around 1-10% in hospitalized patients. It is more common in people with muscle destruction like military recruits, sickle cell patients, drug abusers. 

Electrolyte imbalance can be caused by several conditions like;

• Intense exercise
• Prolonged periods of vomiting or diarrhea
• Poor intake like in eating disorders
• Kidney failure
• Hypoparathyroidism
• Vitamin D deficiency
• Malnutrition 
• Type 1 diabetes
• Trauma like severe burns
• Medications, including diuretics
• Congestive heart failure
• Cancer treatment
• Pancreatitis 

Signs and symptoms depend upon the imbalanced electrolyte and its severity. You may not show any signs or symptoms in the initial stages. Most of the electrolyte imbalances give the following symptoms;

• Irregular heartbeat
• Fast heart rate
• Increased thirst, 
• Excess urination
• Fatigue
• Nausea
• Vomiting
• Diarrhea or constipation
• Abdominal cramping
• Muscle cramping
• Muscle weakness
• Irritability
• Confusion
• Lethargy
• Headaches
• Numbness and tingling

The life-threatening symptoms are:

• Confusion 
• Chest pain
• Convulsions or seizures
• Coma

After taking a history and performing a physical examination, your doctor will advise a simple but important blood test called An electrolyte panel test or a metabolic panel test that can measure the levels of electrolytes in the blood and, hence, detect any imbalances present. This test can also measure the acid-base balance and kidney function.  Later on, this test can monitor the progress during treatment. The underlying illness has to be diagnosed too to prevent further episodes. Further testing can be advised to diagnose and treat the causative diseases based on the history and examination. 

The signs and symptoms of electrolyte imbalance can also be due to the following disorders, which should be ruled out to progress towards an efficient treatment;

• Any severe infection
• Neurological infections or encephalopathy 
• Dehydration
• Adrenal Crisis
• Alcoholism
• Cardiogenic Pulmonary Edema
• Cirrhosis
• Hypothyroidism
• Hypoalbuminemia
• Metabolic Alkalosis

Once the diagnosis is made, your doctor will progress towards the treatment, starting with correcting the imbalance. For example, if an electrolyte is high, your doctor will try to remove the excess from the body using various methods. If the electrolyte is low, it will be replaced. Your doctor may use the following approach;

Correcting Dehydration or Overhydration: If your body’s water content is lost, you will be given oral or IV fluids. If there is an excess of water, you would be advised to restrict water intake. For example;

• Intravenous normal saline
• Intravenous Ringers lactate

Treating Underlying Medical Problem: many diseases can cause electrolyte imbalance. Treating them is necessary to restore the normal levels. For example;

• Controlling diabetes
• Dialysis for kidney failure
• Surgical removal of parathyroid glands for hyperparathyroidism
• Treating cancers
• Treating severe infections, etc. 

Adjusting Electrolytes: the missing electrolytes are given either in the form of tablets or injections. For the excess electrolytes, some medicines or binders are given for eradication. For example;

• For calcium deficiency; calcium carbonate
• For magnesium deficiency; magnesium oxide, IV magnesium chloride
• Fro potassium deficiency or hypokalemia; IV potassium chloride
• For correcting hyperkalemia; Intravenous calcium gluconate, insulin, and glucose are given.
• It is important to correct magnesium levels to correct other electrolyte deficiencies like hypocalcemia. 

Monitoring; as the prevalence of electrolytes disturbance is high in hospitalized patients, they must be monitored regularly for the electrolytes during their treatment. The patients treated for the electrolyte imbalance should also be monitored to track the progress of correction. 

Prognosis depends upon the severity of the deficiency, the arrival of the patient at the right time, efficiency of the diagnosis, and management of the disorder. Usually, the electrolytes imbalance is easily diagnosed by the blood test and corrected on time. However, the chances of deaths are high in significantly older adults, very young children, and critically ill patients.

Electrolyte imbalances can be easily prevented by learning about them and the diseases that can cause them and making lifestyle modifications accordingly, especially if you are a patient of some chronic illness that makes you susceptible to electrolyte disorders. 

• Stay hydrated, especially in hot weather or while performing strenuous exercises.
• Eat a balanced diet rich in fruits and vegetables that are good sources of these essential minerals. For example, Sodium and chlorides are found in table salt, dill pickle, tomato juices, sauces, and soups. Calcium is found in milk, yogurt, sardines, green leafy vegetables. Potassium is found in bananas and potatoes with their skin. Etc. 
• Be cautious of drinking an excess of fluids
• Stay vigilant for correcting dehydration during vomitings and diarrhea 
• Learn about any chronic illness you are suffering from and try to stay alert to prevent the electrolyte imbalance