electrolyte disturbance



OVERVIEW

Definition.

Electrolyte disorders are phenomena in which the values of one or more of the common ions, such as sodium, potassium, calcium, magnesium, and phosphorus, are not within the normal range.

Types

By ion type

Sodium ion metabolism disorder: the normal value of serum sodium ion concentration is 135~145mmol/L, higher than 145mmol/L for hypernatremia, lower than 135mmol/L for hyponatremia.

Disorders of potassium ion metabolism: the normal value of serum potassium ion concentration is 3.5~5.5mmol/L, higher than 5.5mmol/L is hyperkalemia, lower than 3.5mmol/L is hypokalemia.

Disorders of calcium metabolism: the normal value of serum calcium ion concentration is 2.25~2.75mmol/L, higher than 2.75mmmol/L is hypercalcemia, lower than 2.25mmol/L is hypocalcemia.

Disorders of phosphorus metabolism: the normal value of inorganic phosphorus concentration in serum is 0.8~1.45mmol/L, lower than 0.8mmol/L is hypophosphatemia, higher than 1.45mmol/L is hyperphosphatemia.

Disorders of magnesium metabolism: the normal value of serum magnesium concentration is 0.75~1.25mmol/L, higher than 1.25mmol/L is hypomagnesemia, lower than 0.75mmol/L is hypomagnesemia.

Morbidity

Electrolyte disorders are most often seen in middle-aged and elderly patients with chronic diseases of the combined heart, lungs, kidneys, and other organs, and there is no information on the incidence of overall electrolyte metabolism disorders.

Disorders of sodium metabolism are the most common electrolyte disorders in clinical practice.

Disorders of potassium ion metabolism are most commonly seen in patients with cardiac and renal insufficiency.

Disorders of calcium and phosphorus metabolism are most common in patients with thyroid and parathyroid dysfunction.

Causes

Causes

Electrolyte balance in the body refers to the state in which the body maintains a relative equilibrium between intake and normal metabolic discharge. Therefore, the causes of electrolyte disorders can be broadly categorized into intake and discharge disorders. The types and causes of electrolyte disorders are analyzed below.

Sodium metabolism disorder

Hyponatremia: excessive loss of sodium via digestive fluids due to vomiting, excessive loss of sodium via urine due to interstitial nephropathy and renal tubular acid secretion disorders, and large amounts of body fluids collecting in the third interstitial space due to pleurisy and peritonitis.

Hypernatremia: extensive burns, massive application of mannitol, nasal high protein diet, esophageal cancer leading to inadequate water intake, hyperthermia, etc.

Disorders of potassium metabolism

Hypokalemia: severe vomiting and diarrhea, gastrointestinal obstruction, long-term application of furosemide or thiazide diuretics, large amount of glucose or insulin injection, etc.

Hyperkalemia: Intravenous potassium supplementation or input of large amounts of stored blood leads to excessive potassium intake; when hemolytic reaction or crush syndrome occurs, intracellular potassium ions are released into the blood too much; when acidosis occurs, hydrogen-potassium exchange is strengthened, and hydrogen-sodium exchange is weakened, which leads to the elevation of blood potassium.

Calcium metabolism disorders

Hypocalcemia: vitamin D deficiency, chronic renal failure, acute pancreatitis, hypoparathyroidism, obstructive jaundice, liver cirrhosis, etc.

Hypercalcemia: hyperthyroidism, hyperparathyroidism, bone metastasis of malignant tumors will lead to elevated blood calcium.

Disorders of phosphorus metabolism

Hypophosphatemia: vomiting, diarrhea, dyspepsia, etc. lead to insufficient absorption of phosphorus through the small intestine; diabetes mellitus, hyperparathyroidism, etc. can also lead to hypophosphatemia.

Hyperphosphatemia: can be seen in acute and chronic renal insufficiency, acute acidosis, malignant tumors, hypoparathyroidism, vitamin D poisoning.

Magnesium metabolism disorder

Hypomagnesemia: prolonged fasting or anorexia leading to insufficient magnesium intake; prolonged gastrointestinal decompression and diarrhea, leading to excessive loss of magnesium via digestive juices; prolonged application of diuretics, excessive loss of magnesium via urine.

Hypermagnesemia: it can be seen in renal failure, hypoadrenocorticism, hypothyroidism, diabetic ketoacidosis and so on.

Predisposing factors

Age factor

Children’s organ system is not fully developed, the elderly heart, lungs, kidneys and other organs decline in function, resulting in a variety of micronutrient intake or discharge obstacles.

Disease factors

Endocrine system: hyperthyroidism, parathyroid adenoma, diabetes, etc.

Cardiovascular system: pulmonary heart disease, cardiac insufficiency, etc.

Urinary system: interstitial nephropathy, nephrotic syndrome, glomerulonephritis, etc.

Digestive system: esophageal cancer, acute enteritis, irritable bowel syndrome, etc.

Others

Inadequate intravenous supplementation of nutrients.

Postoperative digestive tract absorption dysfunction.

Symptoms

Main Symptoms

Different types of electrolyte disorders have different symptoms.

Sodium ion metabolism disorder

Hyponatremia: there may be nausea, vomiting, dizziness, fatigue, etc.

Hypernatremia: there may be dry mouth, thirst, oliguria, which may lead to drowsiness, convulsions, coma, etc. in severe cases.

Disorders of potassium ion metabolism

Hypokalemia: there may be nausea, vomiting, muscle weakness, panic, etc. It may be accompanied by metabolic alkalosis and paradoxical aciduria.

Hyperkalemia: there may be muscle weakness, paralysis, severe cardiac arrest, may be accompanied by metabolic acidosis, paradoxical alkaline urine.

Calcium ion metabolism disorder

Hypocalcemia: there may be muscle cramps, convulsions, chicken chest, dry skin, etc.

Hypercalcemia: there may be nausea, vomiting, fatigue and weakness, difficulty in mental concentration, insomnia, depression, confusion or even coma.

Disorders of phosphorus metabolism

Hypophosphatemia: there may be agitation, confusion, and in severe cases, it may progress to rigor mortis and coma.

Hyperphosphatemia: High phosphorus itself does not produce specific clinical symptoms. Acute hyperphosphatemia increases the risk of calcium and phosphorus deposition, which can lead to metastatic calcification of soft tissues, including the kidneys, causing acute renal failure.

Disorders of magnesium ion metabolism

Hypomagnesemia: may have muscle tremors, convulsions, irritability, and seizures.

Hypermagnesemia: belching, vomiting, constipation and urinary retention may be present.

Complications

Metabolic acidosis

In hyperkalemia, blood potassium concentration increases, intracellular and extracellular hydrogen and potassium exchange is enhanced, at the renal tubules, hydrogen and sodium exchange is weakened, potassium and sodium exchange is enhanced, metabolic acidosis and paradoxical alkaluria occur.

Metabolic alkalosis

In hypokalemia, blood potassium concentration decreases, extracellular hydrogen ions increase into the cell, potassium-sodium exchange at the renal tubule is weakened, and hydrogen-sodium exchange is enhanced, resulting in metabolic alkalosis and paradoxical aciduria.

Kidney stones

Elevated blood calcium, easy to accumulate at the renal tubules, basement membrane calcification, advanced stage can form kidney stones.

Consultation

Department of Medicine

Emergency Department

When there is severe diarrhea, severe vomiting, blurred consciousness, convulsions, etc., it is recommended to consult a doctor immediately.

Endocrinology

When there are symptoms such as protruding eyes, irritability, irritability, excessive drinking, excessive eating, excessive urination, weight loss, etc., it is recommended to consult a doctor promptly.

Gastroenterology

When symptoms such as diarrhea, vomiting, abdominal pain, poor appetite, etc. occur, prompt medical attention is recommended.

Preparation for medical treatment

Information on how to get to the doctor: registration, preparation of documents, and common problems.

Tips for the doctor

Wear loose clothing, not dresses or jumpsuits, to facilitate examination.

If you have vomited, take a picture of the vomit for the doctor’s reference.

Preparation Checklist

Pay special attention to the time of onset of symptoms, special manifestations, etc.

Any nausea, vomiting, diarrhea, etc.?

Any bone pain?

Any dry mouth, thirst, low urine output, etc.?

Any muscle weakness, convulsions?

How long have these symptoms lasted?

Any history of high blood pressure, diabetes mellitus?

Any history of gastrointestinal surgery?

Any history of kidney disease, such as interstitial nephropathy, nephritis, etc.?

Test results in the last six months, which can be brought to the doctor’s office

Laboratory tests: blood routine, blood creatinine, urea nitrogen, urine routine, blood glucose, blood biochemistry.

Imaging tests: renal CT, chest and abdominal CT, gastroenteroscopy.

Medication used in the last 3 months, if there is a medicine box or package, you can bring it to the doctor

Diuretics: hydrochlorothiazide, furosemide, etc.

Glucocorticoids: hydrocortisone, dexamethasone, etc.

Calcium: calcium gluconate, etc.

Diagnosis

Diagnosis is based on

Medical history

There may be a history of hyperthyroidism, parathyroid adenoma, diabetes mellitus, pulmonary heart disease, cardiac insufficiency, interstitial nephropathy, nephrotic syndrome, glomerulonephritis, acute enteritis, and irritable bowel syndrome.

Clinical manifestations

Hyponatremia: nausea, vomiting, dizziness may be present.

Hypernatremia: there may be thirst, weakness, oliguria, convulsions, etc.

Hypokalemia: there may be muscle weakness, nausea, vomiting, etc. ECG may show u wave.

Hyperkalemia: there may be weakness, muscle paralysis, and in severe cases, cardiac arrest, and ECG may show hyperacute T wave.

Hypocalcemia: there may be numbness of the corners of the mouth, epilepsy, etc., and may manifest as chicken chest, etc.

Hypercalcemia: there may be fatigue, nausea, vomiting, and so on.

Hypophosphatemia: there may be agitation and confusion, which may progress to rigor mortis and coma in severe cases.

Hyperphosphatemia: may have oliguria, etc.

Hypomagnesemia: there may be muscle tremor, convulsions, irritability, epilepsy, and so on.

Hypermagnesemia: belching (hiccups), vomiting, constipation and urinary retention may be present.

Laboratory tests

are the gold standard for the diagnosis of this disease.

Normal range of blood electrolytes: sodium ion concentration 135~145 mmol/L; potassium ion concentration 3.5~5.5 mmol/L; calcium ion concentration 2.25~2.75 mmolo/L; phosphorus concentration 0.8~1.45 mmol/L; magnesium concentration 0.75~1.25 mmol/L.

Measurement of 24-hour urinary electrolyte excretion is also required to determine the etiology.

It is an auxiliary guidance for determining the original disease, and renal insufficiency may have elevated blood creatinine and urea nitrogen.

Imaging

The common examination sites are thyroid, parathyroid, abdomen, pelvis, appendix, etc..

It is mainly used for the auxiliary diagnosis of the primary cause of the disease, and the examination site is clarified according to the patient’s symptoms and signs.

Common tests include chest CT, abdominal CT, pelvic CT, and so on.

It is mainly used for the auxiliary diagnosis of the primary cause of the disease, and the examination site is clarified according to the patient’s symptoms and signs.

Electrocardiogram

It can indirectly reflect serum potassium metabolism.

Differential diagnosis

Cerebral hemorrhage

Similarities: In the case of cerebral hemorrhage, symptoms such as convulsions and muscle weakness may occur, which are similar to the symptoms of electrolyte disorders.

Differences: Differential diagnosis can be made with the help of brain CT examination and electrolyte examination. In the case of cerebral hemorrhage, intracranial hemorrhagic foci can be seen on brain CT.

Hypoglycemia

Similarity: In hypoglycemia, symptoms such as fatigue, panic, palpitation, etc. may occur, similar to electrolyte disorders.

Differences: Differential diagnosis can be made with the help of blood glucose measurement and electrolyte examination, and there can be a decrease in blood glucose concentration in hypoglycemia.

Epilepsy

Similarities: The disease can also induce epilepsy, which needs to be differentiated from epilepsy caused by other etiologies.

Differences: Differential diagnosis can be made by asking whether there is a history of epilepsy, history of medication, EEG, electrolyte level, and so on.

Treatment

Aim of treatment: search for primary disease, treat and correct electrolyte disorders.

Treatment principle: treat the primary disease, correct electrolyte disorders, and closely monitor electrolyte changes during treatment.

Drug treatment

Commonly used drugs include magnesium sulfate, potassium chloride solution, furosemide, calcium gluconate and so on. The following medications are different depending on the cause.

Disorders of sodium metabolism

Hyponatremia: Correct the primary cause, in the case of low volume, blood volume needs to be replenished, commonly used replenishment solutions include saline, glucose saline, sodium bicarbonate, Ringer’s solution, and plasma. In high volume situation, sodium restriction, diuretics and blood purification are needed.

Hypernatremia: Correction of the primary etiology requires control of sodium intake and inappropriate sodium input, and infusion of hypotonic saline if necessary.

Disorders of potassium metabolism

Hypokalemia: correct the primary etiology, potassium supplementation, oral potassium supplementation, intravenous potassium supplementation, etc., such as potassium citrate granules, potassium chloride solution, etc. When intravenous potassium supplementation is performed, attention should be paid to the fact that the speed should not be too fast, and follow the principle of replenishment of potassium at the sight of urine.

Hyperkalemia: actively treat the primary disease, discontinue potassium-supplementing drugs, can infuse polarizing solution (hypertonic glucose solution combined with insulin) to promote the transfer of extracellular potassium to intracellular, use calcium gluconate to fight against hyperkalemia, and diuretics, e.g., furosemide, to promote the elimination of potassium from the kidneys.

Calcium metabolism disorders

Hypocalcemia: correct the primary etiology, supplement calcium, and administer calcium gluconate intravenously when accompanied by acute symptoms such as convulsions and laryngospasm.

Hypercalcemia: use collaterals diuretics, such as furosemide, to promote urinary calcium excretion; apply calcitonin and diphosphonates to inhibit bone resorption.

Disorders of phosphorus metabolism

Hypophosphatemia: actively correct the primary disease, can choose foods containing more phosphorus, such as milk, fish, etc.; severe hypophosphatemia and obvious symptoms can be intravenous phosphorus supplementation.

Hyperphosphatemia: actively treat the primary disease, chronic hyperphosphatemia need to limit the intake of phosphorus in the diet, apply oral phosphorus binding agent, such as calcium salt, aluminum hydroxide, etc..

Magnesium metabolism disorder

Hypomagnesemia: effective treatment is needed to address the cause. Oral magnesium supplementation, such as magnesium oxide, magnesium hydroxide; such as oral absorption obstacles or severe hypomagnesemia patients can be supplemented with magnesium from the vein, such as magnesium sulfate.

Hypermagnesemia: mild hypermagnesemia with normal renal function does not need special treatment; those with obvious cardiovascular symptoms can be injected with calcium immediately, such as 10% calcium chloride 5~10ml intravenous slow injection.

Surgical treatment

Usually electrolyte disorders do not need surgical treatment, but the presence of parathyroid adenoma, pheochromocytoma and other cases can be considered for surgical treatment.

Other treatments

Dialysis

Including hemodialysis and peritoneal dialysis, which can be used for kidney failure, uremia, etc.

Prognosis

Cure

Patients with mild electrolyte disorders and normal renal function have a better prognosis.

The prognosis is generally better for patients with severe chronic diseases in combination, such as heart failure and severe renal insufficiency, after active treatment of the primary disease.

Harmful

A small number of patients with refractory electrolyte metabolism disorder may cause damage to the heart and brain if they cannot get effective treatment in time, and in serious cases, it may lead to cardiac arrest, coma or even death.

Daily

Daily Management

Dietary management

Pay attention to dietary structure, balanced diet and reasonable meal arrangement.

People with hyponatremia can add more sodium salt in food; people with hypokalemia can eat more bananas, oranges, etc.; people with hypocalcemia can drink more milk; people with hypomagnesemia can eat more green leafy vegetables, soybean products, nuts, etc.; people with hypophosphatemia can choose foods containing more phosphorus, such as milk, fish, etc.

Life management

Exercise appropriately and pay attention to replenish water after exercise.

Pay attention to personal hygiene and wash hands frequently.

If there is long-term bed rest treatment, you need to change bedding regularly and turn over regularly to avoid bedsores.

Avoid staying up late and keep a regular routine.

Follow-up

Follow up regularly to monitor electrolyte changes and treatment effects.

Prevention

Take care to have a balanced diet, do not be picky about what you eat, and eat more vegetables.

Pay attention to food and water hygiene to avoid intestinal infections.

Exercise appropriately to strengthen resistance.

If there is a lot of sweating, prolonged outdoor exercise, etc., it is necessary to replenish water in time, and if necessary, replenish light saline water, etc.