Electrolytes Clinical Significance Causes

Sodium Hyponatremia Depletional hyponatremia – losing Dilutional hyponatremia – gaining sodium

<135 mmol/L water than sodium than water
 diuretics, hypoaldosteronism  overhydration
(Addison disease), diarrhea, or  syndrome of inappropriate
vomiting, and severe burns or antidiuretic hormone (SIADH),
trauma congestive heart failure
 cirrhosis
 nephrotic syndrome.
Hypernatremia >145 Water is lost Sodium is retained
mmol/L  diarrhea  acute ingestion
 excessive sweating  hyperaldosteronism
 diabetes insipidus  infusion of hypertonic solutions
during dialysis
Potassium Hypokalemia <3.0  Decreased dietary intake  diarrhea
mmol/L  hyperaldosteronism  laxative abuse
 diuretics  excess insulin which causes
 vomiting increased cellular uptake of
potassium
Hyperkalemia >5.0  Increased intake  increased red blood cell lysis
mmol/  renal failure  leukemia chemotherapy
 hypoaldosteronism
 metabolic acidosis
Chloride Hypochloremia <98  excessive vomiting  burns
mmol/L  use of diuretics  aldosterone deficiency
Hyperchloremia > 107  prolonged diarrhea  dehydration
mmol/L  renal tubular disease  excess loss of bicarbonate
Bicarbonate Decreased ctCO2  metabolic acidosis  salicylate toxicity
 diabetic ketoacidosis
Increased ctCO2  metabolic alkalosis  severe vomiting
 emphysema
Calcium Hypocalcemia  Hypoparathyroidism  magnesium deficiency
 hypoalbuminemia  vitamin D deficiency
 chronic renal failure
Hypercalcemia  Hyperparathyroidism  malignancy involving bone
 hypothyroidism  renal failure
 acute adrenal insufficiency
Phosphorus Hypophosphatemia  renal failure  lymphoblastic leukemia
 hypoparathyroidism  intense exercise
 neoplastic diseases
Hyperphosphatemia  diabetic ketoacidosis  alcoholism
 hyperparathyroidism  malabsorption syndrome
 asthma
Magnesium Hypomagnesemia  renal failure
 excess antacids
Hypermagnesemia  gastrointestinal disorders  drugs (e.g., diuretic therapy, cardiac
 renal diseases glycosides, cisplatin, cyclosporine)
 hyperparathyroidism  diabetes mellitus with glycosuria
(hypercalcemia  alcoholism due to dietary deficiency
Anion gap Decreased anion gap  hypoalbuminemia
 hypercalcemia.

Increased anion gap  uremia  hypernatremia

 lactic acidosis, ketoacidosis  ingestion of methanol, ethylene
glycol, or salicylate
 pH disorders ctCO2 PCO2 pH Associated disease

 diabetic ketoacidosis due to the production of acetoacetic

acid and p-hydroxybutyric acid
 lactic acidosis due to the production of lactic acid
 poisonings such as salicylate, ethylene glycol, and methyl
Acidosis ↓ N ↓ alcohol
 reduced acid excretion due to renal failure or tubular
acidosis
 loss of bicarbonate due to diarrhea or excessive renal
excretion.
Metabolic
 ingestion of excess alkali (antacids)
 intravenous administration of bicarbonate
 renal bicarbonate retention
Alkalosis ↑ N ↑  prolonged diuretic use
 loss of hydrochloric acid from the stomach after vomiting,
intestinal obstruction, or gastric suction
 glucocorticoid excess as in dishing syndrome
 mineralocorticoid excess as in hyperaldosteronism.

 chronic obstructive pulmonary disease, such as chronic

bronchitis and emphysema
Acidosis N ↑ ↓  ingestion of narcotics and barbiturates, and
 severe infections of the central nervous system such as
meningitis.

Respirator  hypoxia
y  anxiety
 nervousness
Alkalosis N ↓ ↑  excessive crying
 pulmonary embolism
 pneumonia
 congestive heart failure
 salicylate overdose

Process ctCO2 PCO2 pH

Respiratory Metabolic ↓pH →Hyperventilation → ↓PCO2 → ↑pH ↓ ↓ N
Compensator acidosis
y Mechanism
Metabolic ↑pH →Hypoventilation → ↑CO2 → ↑H2CO → ↑cdCO2 →↓pH ↑ ↑ N
alkalosis

Renal Resipratory Kidney→ ↑CHCO3 → ↑ cHCO3:cdCO2 → ↑pH ↑ ↑ N

Compensator acidosis
y Mechanism

Respiratory excreting bicarbonate = corrects respiratory alkalosis ↓ ↓ N

alkalosis