Have you ever felt unexplainably exhausted, dizzy, or plagued by sudden muscle cramps? Although these symptoms can be triggered by many factors, a frequently overlooked culprit is an electrolyte imbalance in your body. These tiny, electrically charged minerals play a massive role in keeping your entire system running smoothly. This article provides an essential guide to understanding electrolyte imbalances—including their root causes and how to prevent them.
1. What is an Electrolyte Imbalance?
Electrolytes are minerals that carry an electric charge (ions) when dissolved in bodily fluids. These include sodium (Na⁺), potassium (K⁺), calcium (Ca²⁺), magnesium (Mg²⁺), chloride (Cl⁻), phosphate (PO₄³⁻), and bicarbonate (HCO₃⁻). Carrying an electric charge allows them to perform vital bodily functions, such as:
- Maintaining the balance of water inside and outside cells.
- Ensuring proper nerve signal transmission and muscle contractions.
- Sustaining heart and kidney functions, as well as regulating blood pressure.
- Balancing blood pH levels.
An electrolyte imbalance occurs when the concentration of these ions in the blood becomes exceeds or falls below normal levels, affecting physiological activities and potentially causing severe consequences if not treated promptly.
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2. Common Types of Electrolyte Imbalances
Electrolyte disturbances usually occur when there is a loss of fluids and electrolytes, such as due to diarrhea, vomiting, high fever…, due to chronic diseases such as kidney failure, heart failure, diabetes…, or side effects of certain medications such as diuretics, corticoids, non-steroidal anti-inflammatory drugs (NSAIDs), insulin, laxatives… or due to an unbalanced diet. Common types of disorders include: low or high blood sodium, potassium, and calcium.
A. Sodium Imbalances
Sodium is a crucial element that regulates fluid balance, maintains acid-base equilibrium, controls blood pressure, and supports nerve function and muscle contraction. Normal blood sodium levels range from 135 to 145 mmol/L.
Hyponatremia (when blood sodium level < 135 mmol/L):
Causes:
- Often occurs due to water loss in diarrhea, sweating, vomiting.
- Commonly found in medical conditions: heart failure, cirrhosis with ascites, nephrotic syndrome, adrenal insufficiency…
- Hyponatremia can also be caused by head injury, intracranial surgery, subarachnoid hemorrhage, stroke, brain tumor, SIADH syndrome (excessive secretion of ADH hormone causing water retention, lowering blood sodium level).
- Due to certain drugs: diuretics, antidepressants, antipsychotics, and some cancer treatment drugs.
Symptoms:
- Depending on the level and rate of decrease in blood sodium concentration, patients will have the following symptoms: low blood pressure, loss of appetite, nausea, and more severe conditions can cause rhabdomyolysis, seizures, confusion, coma.
Hypernatremia (when blood sodium level > 145 mmol/L):
Causes:
- Decreased water consumption: insufficient fluid intake, often due to the thirst mechanism being damaged such as central nervous system damage.
- Endocrine abnormalities such as diabetes insipidus and mineralocorticoid excess can also lead to hypernatremia.
Symptoms:
- Hypernatremia has initial symptoms of thirst, discomfort, fever, nausea, loss of appetite. Symptoms become more severe when there are manifestations such as seizures, delirium, coma, spasticity.
- In our body, potassium plays a very important role, especially for the cardiovascular system, as it is involved in myocardial activity, conduction, and heart rate. Potassium has a normal level in the blood of 3.5 – 5 mmol/L.
B. Potassium Disorders
Hypokalemia (when blood potassium level < 3.5 mmol/L):
Causes:
- There are many causes of hypokalemia including vomiting, severe diarrhea, drug use, chronic alcoholism, anorexia nervosa, and hyperaldosteronism.
- Some medications that can cause hypokalemia include potassium-wasting diuretics (thiazide, furosemide), insulin treatment for patients with ketoacidosis in diabetic patients, laxatives or bowel-cleansing drugs…
Symptoms:
- Hypokalemia leads to muscle weakness, muscle pain, rhabdomyolysis, constipation, nausea, electrocardiogram (ECG) changes, heart rhythm disorders.
Hyperkalemia (when blood potassium level > 5.0 mmol/L):
Causes:
- It can be the result of medication use (potassium-sparing diuretics, ACE inhibitors, NSAIDs).
- Due to medical conditions: acute and chronic kidney failure, adrenal insufficiency, renal tubular disease.
- Due to a diet rich in potassium-containing foods.
Symptoms:
- Clinical signs: when clinical manifestations are present, the patient is usually already in a critical condition such as: tachyarrhythmia, ventricular fibrillation, cardiac arrest.
C. Calcium Disorders:
Calcium is one of the important minerals for the body to form bone and operate neuromuscular functions. Normally, blood calcium level ranges from 2.1 – 2.6 mmol/L.
Hypocalcemia (when blood calcium level < 2.2 mmol/L):
Causes:
- Due to the following medical conditions: post-surgical hypothyroidism, hypoparathyroidism, hungry bone syndrome (HBS) which is a condition where calcium rapidly flows into bones causing prolonged hypocalcemia after parathyroid or thyroid surgery, acute pancreatitis…
- Due to vitamin D deficiency, hypomagnesemia, hyperphosphatemia.
- It can also be induced by medications such as: anti-tumor proliferation drugs, antibiotics, loop diuretics, and those drugs treating hypercalcemia.
- This condition can also be seen in critically ill patients with malabsorption disorders.
- Sometimes hypocalcemia has no found cause.
Symptoms:
- Hypocalcemia can lead to paresthesia accompanied by a feeling of fatigue, palpitations, cramps, muscle spasms of the extremities, seizures…
- Chvostek’s sign (involuntary twitching of facial muscles) and Trousseau’s sign (sudden spasm of the foot, hand) can be observed.
- Hypercalcemia (when blood calcium level > 2.6 mmol/L):
Hypercalcemia (when blood calcium level > 2.6 mmol/L):
Causes:
- More than 90% of cases are due to parathyroid gland disease or malignancy (e.g., primary hyperparathyroidism, multiple myeloma, lymphoma, lung cancer, and breast cancer…)
- Some other causes: Sarcoid disease, Vitamin D toxicity, hyperthyroidism, using Thiazide diuretics causing prolonged hypercalcemia.
Symptoms:
- Clinical symptoms usually appear when blood calcium is above 3 mmol/L (12mg/dL) and tend to be more severe as hypercalcemia progresses rapidly.
- Kidney symptoms include polyuria and kidney stones.
- Other symptoms such as: weakness, vomiting, anemia, fatigue, lethargy, stupor, coma.
- Polyuria, vomiting can be the cause of dehydration, reducing calcium excretion and rapidly worsening hypercalcemia.
- In cases of severe hypercalcemia, it can cause heart rhythm disorders, especially in patients taking digoxin, and increase the risk of cardiac arrest.
3. Principles of Handling Electrolyte Disorders
First, it is necessary to identify the cause leading to electrolyte disturbances to have appropriate and timely treatment direction.
Supplementing or Removing Electrolytes:
- Fluid Resuscitation: If fluid is lost, it can be replenished orally (using ORS solution – as recommended by WHO) or intravenously. During episodes of diarrhea, fever, or vomiting, ORS (Oral Rehydration Salts) solution should be used according to WHO recommendations, mixed according to the correct instructed dosage.
- Removing Excess Electrolytes: Diuretics can be used or dialysis indicated when the patient does not respond to other treatment measures and has life-threatening risks.
Monitoring Patient’s Condition: Continue to closely follow the patient’s condition, including clinical signs and lab results (ABG, ionogram, anion gap) to timely adjust the treatment regimen.
Treating Related Diseases: If electrolyte disorder is the consequence of another disease, it is necessary to treat that primary disease.
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4. Preventive Measures for Electrolyte Disorders
Maintain a Balanced Diet: Fully supplement electrolytes through daily food. Drink enough water, limit excessive salty eating (WHO recommends < 2g sodium/day equivalent to < 5g salt/day), add green vegetables, diverse fruits.
Periodic Health Check-ups: Periodic examinations and electrolyte tests for people with underlying diseases (kidney, heart, endocrine) or taking long-term medications.
Treat Underlying Medical Conditions: Well treat underlying medical conditions to avoid electrolyte imbalance.
Seek Medical Advice: If there is any abnormality, it is necessary to consult a doctor for timely examination and treatment.
5. Conclusion
An electrolyte disorder is a serious condition, especially for people with underlying medical conditions or undergoing long-term medication treatment. However, if patients are detected early and receive correct treatment, they can fully recover and prevent recurrence. When having abnormal symptoms, it is necessary to consult a doctor and not self-treat.
Professional consultation: Pharmacist Tran Thi Cam Thu
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Reference:
1. Quyết định số 1493/QĐ-BYT về việc ban hành tài liệu chuyên môn “Hướng dẫn chẩn đoán và xử trí hồi sức tích cực” ngày 22/04/2015
2. Hướng dẫn chẩn đoán và điều trị bệnh nội tiết – chuyển hóa – Quyết định số 3879/QĐ-BYT ngày 30/09/2014
3. BMJ Best Practice – Overview of Acid-base and Electrolyte Disorders (2024).
4.https://www.rch.org.au/clinicalguide/guideline_index/Electrolyte_abnormalities/
5. WHO – Salt intake: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/3082
6. WHO – UNICEF: CLINICAL MANAGEMENT OF ACUTE DIARRHOEA: https://www.who.int/publications/i/item/WHO_FCH_CAH_04.7