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We need a proper balance of fluids and electrolytes in our body to maintain life (not too high or too low…
just the right amount).
In fact, our body consists of 70% water and below you can see the function of water in our body.
However, this water in our body is not just plain water. It consists of so many substances such
as electrolytes.
processes.
Our body is really “electric” because a lot of the processes it does requires electrical signaling.
For instance, we need a balanced amount of electrolytes for the following functions:
Contraction of muscles
Sending nerve impulses
Creating bones
Balancing the fluids in our body like our cells (via osmosis)
Maintaining the blood’s acid-base balance
When certain electrolyte imbalances occur some of the functions above will present abnormally. For
example with “contraction of muscles”, if certain imbalances occur muscle spasms can present. In
addition, the heart (which is a muscle) can cause an abnormal EKG (which is a test that assesses the
electrical activity in the heart).
Therefore, if a patient is experiencing kidney failure these electrolytes will become imbalanced (many
times too high and the patient will need dialysis to help correct the imbalance).
Other ways electrolyte levels can become imbalanced is if they are lost in the body via an exit route.
Electrolytes at present in the urine, sweat, emesis, blood, and stool (really any type of body substance).
Plus, certain medications can affect electrolyte levels along with trauma like burns or other disease
processes.
So, let’s learn about the 6 major electrolytes that make up our body.
Sodium:
What is Sodium?
It’s a very important electrolyte that helps regulate water inside and outside of the cell. And it helps with
muscle contraction and transmission of nerve impulses.
Sodium mainly hangs out in the OUTSIDE of the cell in fluid and helps water move inside and outside the
cell as needed.
So for example, when blood levels of sodium drop in the blood it affects the cells because suddenly water
starts to rush into the cell. This causes the cell to swell. On the flip side, when too much sodium is outside
the cell, water from inside the cell starts to leave and the cell shrinks.
Hyponatremia
Causes:
Aldosterone: regulates blood pressure and causes water and sodium to be kept by the
kidneys but in turn excretes potassium
Low amount of aldosterone: would cause the kidneys to not reabsorb much sodium
and drop blood levels and in turn would cause the kidneys to keep potassium
(leading to hyperkalemia)
SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion): too much ADH is
released causing the body to retain water which dilutes the sodium level.
Overload of fluid (dilutes sodium) with congestive heart failure, hypotonic fluids infusions,
renal failure
Signs and Symptoms of Hyponatremia
Abdominal cramping
Lethargic
Spasms of muscles
Hypernatremia
Causes:
Cushing’s Syndrome (high cortisol can cause sodium retention and low potassium)
Primary Hyperaldosteronism (Conn’s Syndrome)
too much production of aldosterone (retain sodium along with fluid and excrete potassium)
hypertonic solutions
corticosteroids
Not drinking enough water or losing too much water (vomiting, diarrhea, diabetes insipidus…
urinating so much fluid out, sweating, burns)
increased intake of sodium
Signs and Symptoms of Hypernatremia
Fatigue
Chloride
What is Chloride?
Chloride plays a role with acid-base balance in the body along with balancing the fluids in our body by
working with sodium to maintain osmotic pressure. Also, sodium and chloride really go together, and if
sodium is decreased, chloride is likely to be decreased as well.
Furthermore, chloride is needed to make hydrochloric acid, which plays a huge role in food digestion. The
kidneys help maintain chloride blood levels by taking what you don’t need and excreting it in the urine.
Chloride is also excreted through sweating and gut juices.
Therefore, if chloride is imbalanced (especially high) it may be a kidney problem because specific parts of
the nephron remove chloride from the blood and place it in the urine (if the kidneys aren’t functioning right
this can’t happen so more stays in the blood).
Hypochloremia
Low chloride levels in the blood ( <95 mEq/L)
Causes:
Loss of Chloride: GI system (vomiting, gastric juice loss via NG tube suction or ileostomy)
Diuretics (thiazides and loop diuretics affect how renal tubules reabsorb sodium and chloride which
causes more loss of the ions in the urine)
Burns
Cystic fibrosis (high amounts of chloride in the sweat)
Metabolic alkalosis (increase in bicarbonate leads to low levels of chloride…they have an opposite
relationship due to how each ion shifts in the red blood cells for proper gas exchange)
Fluid overload (diluting extracellular fluid: CHF, SIADH (Syndrome of Inappropriate Antidiuretic
Hormone Secretion): too much ADH is released causing the body to retain water, which dilutes the
sodium level)
Signs and symptoms of hypochloremia tend to be associated with whatever is causing the low level
(rather than the level being low itself, so you want to look at what is causing the low level to identify the
signs and symptoms) and tends to look like hyponatremia signs and symptoms but you may see:
Causes:
Potassium
What is Potassium?
It’s an electrolyte that is mainly found in the intracellular part of the cell (inside of the cell) compared to the
extracellular (outside of the cell), which is where sodium is mainly found. Sodium and potassium are
affected by each other.
Typically, if the sodium levels increase (potassium decreases) and sodium level decreases (potassium
increases). Therefore, potassium helps with fluid balance like sodium, especially inside the cell. In
addition, potassium is responsible for nerve impulse conduction and muscle contraction.
Hypokalemia:
Causes:
Medications (diuretics “loop diuretics”, corticosteroids, too much insulin (moves potassium from the
blood into the cell which depletes the blood level)
Cushing’s Syndrome (high cortisol…sodium retention…low potassium)
Not consuming enough potassium (starvation)
losing from vomiting, GI suction, sweating
Signs and Symptoms of Hypokalemia:
Try to remember everything is going to be SLOW and LOW. Don’t forget potassium plays a role in muscle
and nerve conduction so muscle systems are going to be messed up and affect the heart, GI, renal, and
the breathing muscles for the lungs.
7 L’s (Low)
1. Lethargy (confusion)
2. Low, shallow respirations (due to decreased ability to use accessory muscles for breathing)
3. Lethal cardiac dysrhythmias (ST depression, shallow T wave, projecting U wave)
4. Lots of urine (frequent urination…kidneys unable to make the urine concentrated)
5. Leg cramps
6. Limp muscles (decrease deep tendon reflexes)
7. Low BP & Heart
Hyperkalemia
Causes:
Burns
Rhabdomyolysis (break down of muscle tissue which releases potassium from the damaged
muscle tissue into the blood)
Addison’s Disease: low secretion of aldosterone (regulates water and sodium in kidneys by
causing the kidneys to reabsorb water and sodium and excrete potassium
Low amount of aldosterone would cause the kidneys to not reabsorb much sodium but
excrete it and reabsorb more potassium and increase blood levels
Renal failure (unable to excrete potassium and builds up in blood)
Excessive intake of potassium
Medications (potassium-sparing diuretics: spironolactone, ACE inhibitors, NSAIDS)
Signs and Symptoms of Hyperkalemia:
“Murder”
Muscle weakness
Rhythm changes: Tall peaked T-waves, prolonged PR interval (increased higher p-wave not visible)
Calcium
What is Calcium?
Calcium plays a huge role in bone and teeth health along with muscle contraction/nerve transmission,
cell, and blood clotting. Calcium is absorbed in the GI system (so a diet rich in calcium is essential for
maintaining calcium blood levels), and it’s stored in the bones. Therefore, if blood levels drop the bones
will release some calcium in the blood to help maintain levels, but this can be unhealthy overtime and
lead to osteoporosis.
To maintain balanced calcium blood levels, it has to have some help from:
Vitamin D helps play a role in calcium absorption in the GI system. In addition, hormones play a role
with maintaining balanced calcium levels like:
Therefore, any problem with these hormones or the structures that produce these hormones can lead to
an imbalance of calcium levels.
In addition, phosphorus and calcium affect each other in the opposite way. For instance, if
phosphorus levels are high in the blood, calcium will decrease and vice versa. They are always doing the
opposite (remember this because it is important for the causes of hypocalcemia).
Hypocalcemia:
Causes:
bisphosphonates (help make bones stronger: decreases the release of calcium from the
bones into the blood which can lower blood levels of calcium)
antibiotics…aminoglycosides (“mycin”)…waste calcium by the kidneys
anticonvulsants (phenobarbital, phenytoin) alters vitamin D levels
Signs and Symptoms of Hypocalcemia
Remember “CRAMPS”
Convulsions
Reflexes hyperactive
Trousseau’s Sign: You do this by using a blood pressure cuff and place it around the
upper arm and inflate it to a pressure greater than the systolic blood pressure and hold it in
place for 3 minutes. If it is positive: hand will draw in toward the body and flexion will occur
at the wrist, thumb, and MCP (metacarpophalangeal) joints but the fingers remain extended.
To elicit this response you would tap via the masseter muscle at the jaw’s angle and
the facial muscles on the same side of the face will contract momentarily (the lips will
twitch).
Hypercalcemia:
Overall WEAK”
Absent reflexes (decreased), altered mental status, abdominal distention from constipation
Magnesium
What is Magnesium?
Magnesium is another major ion found inside the cell just like potassium. Magnesium plays a big role with
muscle and nerve function.
For example, it plays a big role with how ATP works with the sodium-potassium pump. Magnesium helps
by binding with ATP (which needs mag ions to function) so 3 sodium ions can move out of the cell and 2
potassium ions can move in the cell…without proper mag levels this function fails to work properly.
Also, mag helps with muscle relaxation. Calcium and mag are competitors in muscle contraction. In a
nutshell, calcium plays a vital role in muscle contraction, and magnesium challenges the binding spot of
calcium to cause muscles to relax. Therefore, without enough magnesium to calm muscle contractions
down, cramping and spasms may occur.
Plus, magnesium is vital for how nerves transmit signals, how our vessels work to maintain blood
pressure, and how the heart muscle contracts.
Magnesium is absorbed in the gut, specifically the small intestine (keep this in mind…because if there is a
problem with the small intestine, magnesium absorption can be affected). In addition, it’s excreted through
the kidneys.
When magnesium levels are imbalanced, many times other electrolytes imbalances will occur as well
(specifically potassium and calcium levels).
Hypomagnesemia:
Causes:
When magnesium is too low to calm things down, excitability will be occurring (opposite for
hypermagnesemia).
“Twitch”
Weakness
Torsade’s de pointes (abnormal heart rhythm that leads to sudden cardiac death…seen in
alcoholism) Tetany (seizures) and other EKG changes that go along with calcium and potassium
decrease
Hypertension
Hypermagnesemia:
Causes:
Not very common…but can happen when trying to correct hypomagnesemia (too much given)
Labor and delivery patients receiving magnesium sulfate for treatment of preeclampsia (assessing
reflexes…don’t want them decreased or absent…means too much mag)
Kidney function is impaired because the kidneys are responsible for excreting magnesium
Signs and Symptoms of Hypermagnesemia
Every system of the body is “Lethargic” (opposite of hypomagnesemia where the body systems are
experiencing hyperexcitability)
Note: You will typically only see symptoms in severe cases of hypermagnesemia (mild cases the patient
may be asymptomatic)
Lethargy (profound)
EKG changes with prolonged PR & QT interval and widened QRS complex
Hypotension
Phosphate
What is phosphate?
Phosphate helps build bones/teeth and plays a role in nerve/muscle function. Majority of the phosphate is
stored in the bones. Therefore, it plays a vital role in bone and teeth health. It’s absorbed through food we
eat and is excreted through the kidneys (if there is a renal insufficiency, phosphate levels can be high
because the kidneys are failing to excrete it).
Also, the parathyroid gland plays a role in the regulation phosphate just like it did with calcium.
It’s important to remember that calcium and phosphate can many times influence each other in
opposite ways. For example, when calcium levels increase, in turn phosphate levels decrease (vice
versa).
Hypophosphatemia
Causes:
This happens when food is reintroduced after the body has been in starvation mode (hence
the body went into survival mode and is depleted of almost everything). When nutrition is
introduced, the body releases insulin due to the increased blood sugar from the food, which
causes the body to rapidly use the already low stores of phosphate. Phosphate is needed
by the body’s cells to change glucose into energy. This process further depletes phosphate
levels).
Overactive parathyroid gland (parathyroid plays a role in maintaining calcium and phosphate levels
and it normally inhibits reabsorption of phosphate by the kidneys)
Low vitamin D intake
Severe burns (moves phosphate intracellularly)
Alcoholism (malabsorption and poor diet)
Signs and Symptoms of Hypophosphatemia
Typically seen when the levels are severely low (not mildly)
“Bone”
Hyperphosphatemia
Causes:
Convulsions
Reflexes hyperactive
Arrhythmias