Electrolytes

Electrolytes are ionized molecules found throughout the blood, tissues, and cells of the body. These molecules, which are either positive (cations) or negative (anions), conduct an electric current and help to balance pH and acid-base levels in the body. Electrolytes also facilitate the passage of fluid between and within cells through a process known as osmosis and play a part in regulating the function of the neuromuscular, endocrine, and excretory systems. The balance of the electrolytes in our bodies is essential for normal function of our cells and our organs.

The serum electrolytes include:

• Sodium (Na). A positively charged electrolyte that helps to balance fluid levels in the body and facilitates neuromuscular functioning.
• Potassium (K). A main component of cellular fluid, this positive electrolyte helps to regulate neuromuscular function and osmotic pressure.
• Calcium (Ca). A cation, or positive electrolyte, that affects neuromuscular performance and contributes to skeletal growth and blood coagulation.
• Magnesium (Mg). Influences muscle contractions and intracellular activity. A cation.
• Chloride (CI). An anion, or negative electrolyte, that regulates blood pressure.
• Phosphate (HPO4). Negative electrolyte that impacts metabolism and regulates acid-base balance and calcium levels.
• Bicarbonate (HCO3). A negatively charged electrolyte that assists in the regulation of blood pH levels. Bicarbonate insufficiencies and elevations cause acid-base disorders (i.e., acidosis, alkalosis).

Sodium

Sodium is the major positive ion in fluid outside the cells. Sodium regulates the total amount of water in the body and the transmission of sodium into and out of individual cells also plays a role in critical body functions. Many processes in the body, especially in the brain, nervous system, and muscles, require electrical signals for communication. The movement of sodium is critical in generation of these electrical signals. Too much or too little sodium therefore can cause cells to malfunction, and extremes in the blood sodium levels (too much or too little) can be fatal.

HYPERNATREMIA. Sodium helps the kidneys to regulate the amount of water the body retains or excretes. Consequently, individuals with elevated serum sodium levels also suffer from a loss of fluids, or dehydration. Hypernatremia can be caused by inadequate water intake, excessive fluid loss (i.e., diabetes insipidus ,kidney disease, severe burns, and prolonged vomiting or diarrhea), or sodium retention (caused by excessive sodium intake or aldosteronism). In addition, certain drugs, including loop diuretics, antihypertensive medications may cause elevated sodium levels.

Symptoms:

• thirst
• orthostatic hypotension
• dry mouth and mucous membranes
• dark, concentrated urine
• loss of elasticity in the skin
• irregular heartbeat (tachycardia)
• irritability
• fatigue
• lethargy
• heavy, labored breathing
• muscle twitching and/or seizures
• dizziness and fainting
• nausea
• vomiting
• sweating
• fever
• brain dysfunction
• agitation
• restlessness
• irrational behaviors
• seizures
• muscular twitches
• possible coma or death

HYPONATREMIA. Up to 1% of all hospitalized patients develop hyponatremia, making it one of the most common electrolyte disorders. Diuretics, certain psychoactive drugs (i.e., fluoxetine, sertraline, haloperidol), specific antipsychotics(lithium), vasopressin, chlorpropamide, the illicit drug “ecstasy”, and other pharmaceuticals can cause decreased sodium levels, or hyponatremia. Low sodium levels may also be triggered by inadequate dietary intake of sodium, excessive perspiration, water intoxication, and impairment of adrenal gland or kidney function.

Symptoms:

• nausea
• abdominal cramping
• vomiting
• headache
• edema (swelling)
• muscle weakness, spasms or cramps
• paralysis
• disorientation
• slowed breathing
• fainting
• seizures
• coma
• death
• restlessness
• general weakness
• fatigue
• dizziness or fainting

Potassium

Potassium is the major positive ion (cation) found inside of cells. The proper level of potassium is essential for normal cell function. Among the many functions of potassium in the body are regulation of the heartbeat and the function of the muscles. A seriously abnormal increase in potassium or decrease in potassium can profoundly affect the nervous system and increases the chance of irregular heartbeats (arrhythmias), which, when extreme, can be fatal.

HYPERKALEMIA. Hyperkalemia may be caused by ketoacidosis (diabetic coma),myocardial infarction (heart attack), severe burns, kidney failure, fasting, bulimia nervosa, gastrointestinal bleeding, adrenal insufficiency, or Addison’s disease. Diuretic drugs, cyclosporin, lithium, heparin, ACE inhibitors, beta blockers, andtrimethoprim can increase serum potassium levels, as can heavy exercise. The condition may also be secondary to hypernatremia (low serum concentrations of sodium).

Symptoms:

• weakness
• nausea and/or abdominal pain
• irregular heartbeat (arrhythmia
• diarrhea
• muscle pain
• fatigue
• tingling sensation
• slow heart rate

HYPOKALEMIA. Severe dehydration, aldosteronism, Cushing’s syndrome, kidney disease, long-term diuretic therapy, certain penicillins, laxative abuse, some diabetes medications , insulin, congestive heart failure, and adrenal gland impairments can all cause depletion of potassium levels in the bloodstream. A substance known as glycyrrhetinic acid, which is found in licorice and chewing tobacco, can also deplete potassium serum levels.

Symptoms:

• weakness
• fatigue
• paralysis
• increased urination
• irregular heartbeat (arrhythmia)
• orthostatic hypotension
• muscle pain
• tetany
• cramping in arm or leg muscles
• tingling or numbness
• nausea
• vomiting
• abdominal cramping or bloating
• constipation
• heart palpitations
• fainting
• depression
• psychosis
• delirium

Calcium

HYPERCALCEMIA. Blood calcium levels may be elevated in cases of thyroid disorder, multiple myeloma, metastatic cancer, multiple bone fractures, milk-alkali syndrome, hyperparathyroidism and Paget’s disease. Excessive use of calcium-containing supplements and certain over-the-counter medications (i.e., antacids) may also cause hypocalcaemia.

Symptoms:

• fatigue
• constipation
• depression
• confusion
• muscle pain
• nausea and vomiting
• dehydration
• increased urination
• irregular heartbeat (arrhythmia)
• loss of appetite
• excessive thirst
• abdominal pain
• muscle weakness
• muscles and joint aches

HYPOCALCEMIA. Thyroid disorders, kidney failure, severe burns, sepsis, vitamin D deficiency, Hypoparathyroidism and medications such as heparin and glucogan can deplete blood calcium levels.

Symptoms:

• muscle cramps and spasms
• tetany and/or convulsions
• mood changes (depression, irritability)
• dry skin
• brittle nails
• facial twitching
• anxiety
• tingling in fingers and toes
• shortness of breath
• discoloration of the skin
• eczema
• muscle stiffness

Magnesium

HYPERMAGNESEMIA. Excessive magnesium levels may occur with end-stage renal disease, Addison’s disease, or an overdose of magnesium salts.

Symptoms:

• lethargy
• hypotension
• decreased heart and respiratory rate
• muscle weakness
• muscle fatigue
• diminished tendon reflexes
• abdominal cramping
• diarrhea
• confusion
• dizziness
• paralysis
• general weakness
• drowsiness

HYPOMAGNESEMIA. Inadequate dietary intake of magnesium, often caused by chronic alcoholism or malnutrition, is a common cause of hypomagnesaemia. Other causes include malabsorption syndromes, pancreatitis, aldosteronism, burns, hyperparathyroidism, digestive system disorders, and diuretic use.

Symptoms:

• leg and foot cramps
• weight loss
• vomiting
• muscle spasms, twitching, and tremors
• seizures
• muscle weakness
• muscle cramps
• irregular or rapid heart beat
• behavioral disturbances
• irritability
• anxiety
• lethargy
• nausea
• hyperactive reflexes
• impaired muscle coordination
• involuntary eye movements
• vertigo
• difficulty swallowing
• coronary spasms

Chloride

Chloride is the major anion (negatively charged ion) found in the fluid outside of cells and in the blood. An anion is the negatively charged part of certain substances such as table salt (sodium chloride) when dissolved in liquid. Sea water has almost the same concentration of chloride ion as human body fluids. Chloride also plays a role in helping the body maintain a normal balance of fluids. The balance of chloride is closely regulated by the body. Significant increases or decreases in chloride can have deleterious or even fatal consequences:

HYPERCHLOREMIA. Severe dehydration, kidney failure, hemodialysis, traumatic brain injury, and aldosteronism. Drugs such as boric acid and ammonium chloride and the intravenous (IV) infusion of sodium chloride can also boost chloride levels, resulting in hyperchloremic metabolic acidosis.

Symptoms:

• weakness
• headache
• nausea
• cardiac arrest
• dehydration
• diarrhea
• vomiting

HYPOCHLOREMIA. Hypochloremia usually occurs as a result of sodium and potassium depletion (i.e., hyponatremia, hypokalemia). Severe depletion of serum chloride levels causes metabolic alkalosis. This causes alkalization of the bloodstream.

Symptoms:

• mental confusion
• slowed breathing
• paralysis
• muscle tension or spasm
• Addison’s disease

Phosphate

HYPERPHOSPHATEMIA. Skeletal fractures or disease, kidney failure, hypoparathyroidism, hemodialysis, diabetic ketoacidosis, acromegaly, systemic infection, and intestinal obstruction can all cause phosphate retention and build-up in the blood. The disorder occurs concurrently with hypocalcaemia. Individuals with mild hyperphosphatemia are typically asymptomatic.

Symptoms:

• tingling in hands and fingers
• muscle spasms and cramps
• convulsions
• cardiac arrest

HYPOPHOSPHATEMIA. Serum phosphate levels of 2 mg/dL or below may be caused by hypomagnesaemia and hypokalemia. Severe burns, alcoholism, diabetic ketoacidosis, kidney disease, hyperparathyroidism, hypothyroidism, Cushing’s syndrome, malnutrition, hemodialysis, vitamin D deficiency, and prolonged diuretic therapy.

Symptoms:

• muscle weakness
• weight loss
• bone deformities (osteomalacia)

Bicarbonate

The bicarbonate ion acts as a buffer to maintain the normal levels of acidity (pH) in blood and other fluids in the body. Bicarbonate levels are measured to monitor the acidity of the blood and body fluids. The acidity is affected by foods or medications that we ingest and the function of the kidneys and lungs. The chemical notation for bicarbonate on most lab reports is HCO3- or represented as the concentration of carbon dioxide (CO2). Disruptions in the normal bicarbonate level may be due to diseases that interfere with respiratory function, kidney diseases, metabolic conditions, or other causes.