OVERVIEW

What are electrolytes in electrolyte disorders?

In *Dream of the Red Chamber*, Jia Baoyu said, "Girls are made of water, and men are made of mud." In fact, he was only half right. Regardless of gender, water accounts for more than half of the human body's weight (55%–60%).

The water in the human body contains important substances such as sodium, potassium, calcium, magnesium, chloride, bicarbonate, and hydrogen phosphate. These substances dissolved in water are called electrolytes.

What is an electrolyte disorder?

Under normal circumstances, the electrolyte composition in the human body is stable and remains balanced, which is essential for the normal functioning of various parts, tissues, organs, and cells.

When conditions such as insufficient dietary intake, vomiting, diarrhea, certain genetic diseases, internal medical conditions, surgical trauma, or surgery occur, some electrolytes in the body become imbalanced and deviate from the normal range. This is called electrolyte metabolism disorder (electrolyte disorders), also known as electrolyte imbalance.

What are the dangers of electrolyte disorders?

Electrolyte disorders can be classified as mild, moderate, or severe based on their severity. Severe imbalances can be life-threatening.

Depending on the duration, they can be acute or chronic, with acute disorders often presenting more severe symptoms. Based on the type of imbalance, they can be simple (e.g., only sodium abnormality) or mixed (e.g., abnormalities in multiple electrolytes like sodium and potassium simultaneously).

The manifestations of electrolyte disorders vary depending on the specific imbalance, such as sodium, potassium, or calcium disorders. Different electrolyte imbalances present distinct symptoms, and the underlying causes also lead to varied clinical presentations.

How are electrolyte disorders treated?

Infants, the elderly, and individuals with chronic diseases are more prone to electrolyte disorders.

Treatment primarily involves identifying the underlying cause of the imbalance. Addressing the root cause is key to resolving the issue. If the cause cannot be immediately identified or if the condition is critical or life-threatening, a "corrective" approach can be taken—for example, lowering calcium levels in cases of hypercalcemia or supplementing potassium in cases of hypokalemia.

If the cause of the electrolyte disorder is identified and can be eliminated, the imbalance can be cured. If the cause is unknown or cannot be resolved, the disorder may persist long-term, requiring regular monitoring and ongoing treatment, which can impact health and quality of life.

Are electrolyte disorders common?

Electrolyte disorders are relatively common.

Many diseases can lead to electrolyte imbalances, such as infections with fever, nausea, vomiting, trauma, surgery, gastrointestinal disorders, liver disease, brain disorders, and endocrine diseases (e.g., thyroid, parathyroid, adrenal, or pituitary disorders). These conditions may be accompanied by one or more electrolyte imbalances.

Are electrolyte disorders and acid-base imbalances the same condition?

Acid-base imbalances and electrolyte disorders are not the same, but the two often occur together.

Human blood has a specific acidity level, medically referred to as pH, which normally ranges from 7.35 to 7.45. This is typically measured through arterial blood gas analysis. A pH below 7.35 indicates acidosis, while a pH above 7.45 indicates alkalosis.

Electrolyte disorders, on the other hand, are diagnosed through venous blood tests. If one or more electrolytes—such as sodium, potassium, calcium, magnesium, phosphorus, or chloride—are outside the normal range, an electrolyte imbalance is present.

Certain diseases can cause both electrolyte and acid-base imbalances simultaneously. For example, diabetic ketoacidosis can lead to acidosis along with low sodium and potassium levels.

What are the types of electrolyte disorders?

Electrolyte disorders are classified based on the specific electrolyte imbalance, including hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypomagnesemia, hypermagnesemia, hypophosphatemia, and hyperphosphatemia.

SYMPTOMS

What are the manifestations of electrolyte disorders?

Hyponatremia:

Early symptoms of acute hyponatremia often include nausea and discomfort. In severe cases, it may progress to headaches, drowsiness, confusion, and eventually seizures, coma, and respiratory arrest.

Chronic hyponatremia may manifest as fatigue, nausea, dizziness, vomiting, unsteady gait, forgetfulness, confusion, drowsiness, and muscle cramps.

Hypernatremia:

Early symptoms of acute hypernatremia may include drowsiness, fatigue, weakness, irritability, and agitation. As it progresses, symptoms may involve tremors, convulsions, seizures, and coma.

Chronic hypernatremia (lasting more than 1 day) tends to present with milder and less noticeable symptoms compared to acute cases.

Hypokalemia:

The severity of hypokalemia symptoms correlates with the degree and speed of potassium depletion. Symptoms may include muscle weakness, typically starting in the lower limbs and progressing to the trunk and upper limbs. Severe cases may lead to paralysis, muscle cramps, or rhabdomyolysis.

If respiratory muscles are affected, respiratory weakness may occur, potentially leading to respiratory failure and death. Involvement of gastrointestinal muscles may slow or halt motility, causing bloating, loss of appetite, nausea, and vomiting.

Various arrhythmias may occur, presenting as palpitations. Kidney involvement may lead to polyuria and acid-base imbalances. Reduced insulin secretion due to hypokalemia may cause abnormal blood sugar levels.

Hyperkalemia:

Early symptoms may include limb numbness, extreme fatigue, muscle pain, and pale, clammy limbs. Other manifestations may relate to the underlying cause, such as polyuria and polydipsia in poorly controlled diabetes.

Severe cases may involve muscle weakness, paralysis, bradycardia, arrhythmias, restlessness, fainting, confusion, and sudden death.

Hypocalcemia:

Severe or rapid declines in blood calcium may cause spontaneous hand and foot spasms, abdominal pain, bronchial asthma, laryngeal spasms, or even grand mal seizures, which can be fatal if untreated.

Chronic hypocalcemia may cause numbness or tingling in the lips, nose, or limbs, muscle twitching, and facial muscle contractions when the skin near the ear is lightly tapped. A blood pressure cuff test may induce hand muscle contractions within three minutes.

Long-term hypocalcemia may lead to memory loss, personality changes, depression, anxiety, confusion, intellectual disability in children, and, in some cases, heart failure.

Chronic hypocalcemia may also cause dry skin, dandruff, pigmentation, brittle nails, transverse nail grooves, hair loss, sparse hair, cataracts, increased susceptibility to fungal infections, and dental hypoplasia in children.

Hypercalcemia:

Common symptoms include loss of appetite, nausea, vomiting, abdominal pain, constipation, or even intestinal obstruction. Progression may lead to headaches, muscle weakness, depression, irritability, unsteady gait, speech difficulties, hearing or vision impairment, disorientation, stupor, and psychiatric symptoms.

Hypercalcemia may cause peptic ulcers, acute pancreatitis, lung infections, respiratory distress, or failure. Kidney involvement may result in thirst, polydipsia, polyuria, dehydration, kidney stones, or renal failure. It may also trigger hypertension, arrhythmias, and potentially fatal heart rhythm disturbances if untreated.

Hypomagnesemia:

Neuromuscular symptoms may include hyperexcitability (e.g., tremors, tetany, seizures), muscle weakness, apathy, delirium, and coma. Cardiovascular symptoms may involve abnormal ECG readings and irregular heart rhythms.

It often coexists with calcium or potassium imbalances, leading to related symptoms. Hypomagnesemia is also linked to hypertension, migraines, and asthma.

Hypermagnesemia:

Symptoms include bradycardia, nausea, vomiting, skin vasodilation, and urinary retention. Progression may lead to drowsiness, stupor, confusion, muscle paralysis, respiratory depression, weakened heart contractions, coma, or death.

Hypophosphatemia:

Acute hypophosphatemia may impair oxygen release from hemoglobin, causing brain hypoxia. Severe cases may lead to rhabdomyolysis, hemolysis, infections, coma, or death. Chronic hypophosphatemia may cause rickets or osteomalacia.

Hyperphosphatemia:

Symptoms are usually mild. Severe cases vary based on the underlying cause. If accompanied by hypocalcemia or other metabolic disorders, symptoms may include paresthesia, tetany, abdominal pain, nausea, vomiting, seizures, or impaired consciousness.

Can electrolyte disorders cause seizures?

Severe electrolyte imbalances, such as abnormalities in sodium, potassium, or calcium, may trigger seizures.

How do electrolyte disorders progress?

Electrolyte disorders often arise from triggers like inadequate dietary intake, vomiting, diarrhea, infections, certain medications (e.g., diuretics), genetic disorders, medical conditions (e.g., adrenal insufficiency, parathyroid disorders, chronic kidney disease), or trauma/surgery.

Without timely diagnosis, addressing the cause, and treatment, the imbalance may worsen, affecting multiple organs and potentially leading to organ failure or death.

What severe complications can electrolyte disorders cause?

Acute, severe electrolyte imbalances may affect multiple organs, leading to respiratory failure, kidney failure, arrhythmias, heart failure, coma, or death.

CAUSES

What causes electrolyte imbalance?

Common causes of electrolyte imbalance include:

Inadequate dietary intake (e.g., inability to eat, fasting, swallowing difficulties, cognitive impairment affecting meals);

Excessive electrolyte loss (e.g., vomiting or diarrhea due to gastrointestinal diseases, use of diuretics, increased urination from conditions like hyperglycemia, fever, acute or chronic infections, heatstroke, excessive sweating, surgery, trauma, blood loss, or bleeding);

Endocrine disorders (e.g., syndrome of inappropriate antidiuretic hormone secretion, hypopituitarism, parathyroid disorders, hyperaldosteronism);

Chronic diseases (e.g., kidney failure, liver cirrhosis, heart failure) or genetic disorders (e.g., Bartter syndrome).

Who is prone to electrolyte imbalance?

Individuals with poor dietary intake, newborns, infants, elderly people, patients with chronic diseases or endocrine disorders, and those experiencing acute infections, trauma, or surgery are more susceptible to electrolyte imbalance.

DIAGNOSIS

How to Diagnose Electrolyte Imbalance?

Blood tests for ion panels, referred to as electrolyte tests in some hospitals, or arterial blood gas analysis can determine whether electrolyte imbalance exists.

After diagnosing electrolyte imbalance, identifying the underlying cause is often necessary. This may involve 24-hour urine collection tests or endocrine hormone level assessments.

Blood gas analysis may cause tolerable pain but is completed quickly, so there is no need for concern.

Blood gas analysis is crucial for diagnosing electrolyte imbalances, especially when accompanied by acid-base disorders or respiratory dysfunction. The more relaxed the patient is, the less pain they will feel. During blood collection, avoid hyperventilation or breath-holding to prevent affecting the test results.

What Precautions Should Be Taken for Blood Gas Analysis or Blood Tests for Electrolyte Imbalance?

During blood gas analysis, patients should remain calm to avoid hyperventilation, breath-holding, vomiting, or crying, which may skew results. They should relax, maintain a comfortable position, and lie flat or sit for at least 5 minutes or until breathing stabilizes before blood collection.

Results vary with temperature, so body temperature should be measured beforehand and noted on the test form for lab correction. If the patient is on oxygen therapy (nasal cannula or ventilator), ensure they reach a "stable state" before sampling.

If possible, discontinue oxygen 30 minutes before blood collection, or note the oxygen concentration for accurate analysis.

Certain medications, like fat emulsions, can affect results. Blood should be drawn before administering such drugs or 12 hours after infusion. Alkaline drugs, high-dose penicillin, or ampicillin may temporarily alter pH levels, so blood should ideally be drawn 30 minutes before medication.

Which Diseases Are Easily Confused with Electrolyte Imbalance? How to Differentiate?

Many conditions can cause electrolyte imbalance, so identifying the underlying cause is essential.

Take hyponatremia as an example: further tests like urine osmolality, urine electrolytes, and endocrine hormone levels help distinguish causes.

If urine osmolality is significantly low, consider primary polydipsia or excessive low-osmolar fluid intake (e.g., beer).

If urine osmolality is high, check urine sodium levels. Low urine sodium suggests heart failure, cirrhosis, or nephrotic syndrome.

High urine sodium with diuretic use points to diuretic nephropathy; otherwise, consider SIADH (syndrome of inappropriate antidiuretic hormone secretion), adrenal insufficiency, or hypothyroidism.

TREATMENT

Which department should I visit for electrolyte imbalance?

If acute or severe electrolyte imbalance is suspected, it is recommended to go to the emergency department. For chronic or less severe cases, visit the corresponding department based on the specific cause—for example, endocrinology for endocrine disorders or nephrology for chronic kidney disease.

Can electrolyte imbalance resolve on its own?

Whether electrolyte imbalance can resolve on its own depends on whether the underlying cause can recover naturally and the severity of the imbalance.

For instance, acute gastroenteritis may sometimes heal on its own, so the electrolyte imbalance caused by it can also resolve as the gastroenteritis improves.

However, if the imbalance is due to endocrine disorders or chronic diseases, which cannot self-resolve, the electrolyte imbalance will also persist.

Additionally, severe electrolyte imbalances are unlikely to recover without treatment.

How is electrolyte imbalance treated? Which method works fastest?

Treatment primarily targets the underlying cause of the imbalance to address the root issue.

If the cause cannot be identified immediately, or if the condition is critical or life-threatening, the principle of "remove excess and supplement deficiency" can be applied first—for example, lowering calcium levels in hypercalcemia or replenishing potassium in hypokalemia.

Does electrolyte imbalance require hospitalization?

Hospitalization depends on the cause and severity of the imbalance. Acute, severe cases that may be life-threatening typically require inpatient treatment.

What are the common side effects of medications for electrolyte imbalance?

When the cause is unclear or the condition is critical, the "remove excess and supplement deficiency" approach is often used.

For example, treating hyponatremia involves sodium supplementation, which itself has no significant side effects. However, excessive speed or quantity can lead to neurological side effects or overcorrection.

Can electrolyte imbalance be completely cured?

Whether it can be cured depends on the underlying cause.

If the cause is identifiable and treatable, the imbalance can be resolved. If the cause is unknown or untreatable, the imbalance may persist, requiring long-term management and regular monitoring, which can impact health and quality of life.

DIET & LIFESTYLE

What should patients with electrolyte imbalances pay attention to in their diet?

Patients with different types of electrolyte imbalances or imbalances caused by different underlying conditions have specific dietary requirements, and these cannot be generalized.

For example, the most common electrolyte imbalances after major surgery are hypokalemia and hyponatremia. A well-balanced diet with palatable, easily digestible, low-fat, high-protein, and potassium-rich foods in small, frequent meals, along with increased intake of fresh vegetables and fruits, can aid recovery from postoperative hypokalemia and hyponatremia.

What should patients with electrolyte imbalances pay attention to in daily life?

Patients with different types of electrolyte imbalances or imbalances caused by different underlying conditions have specific lifestyle requirements, and these cannot be generalized.

For instance, patients with psychogenic polydipsia or syndrome of inappropriate antidiuretic hormone secretion (SIADH)-induced hyponatremia need to restrict daily fluid intake, while those with hypernatremia caused by dehydration should drink as much water as possible. Therefore, specific recommendations vary, and patients should consult their doctors for individualized advice.

Do electrolyte imbalances require follow-up testing? How is it done?

Acute and severe electrolyte imbalances can be life-threatening, requiring close monitoring of electrolyte levels. Initially, blood tests for electrolytes or arterial blood gas analysis may be needed every 4–6 hours to adjust treatment and restore electrolyte balance as planned.

For chronic or mild electrolyte imbalances, the frequency of follow-up tests and the specific tests required depend on the patient's condition and the underlying cause of the imbalance.

PREVENTION

How to prevent electrolyte imbalance?

Maintaining a balanced diet, eating regularly, and actively treating chronic diseases can help prevent electrolyte imbalance.

How to prevent recurrence of electrolyte imbalance?

Actively treating the underlying cause of electrolyte imbalance is key to preventing recurrence.

How can patients with electrolyte imbalance prevent complications?

Actively treating the underlying cause, correcting the imbalance promptly, and preventing further deterioration are crucial to avoiding complications.