ELECTROLYTE HOMEOSTASIS
Definition of the Disease
Maintained by feedback mechanisms,
hormones, and organ systems. Also, it is
necessary for body’s normal physiologic
functions
60% of total body water is distributed
intracellularly; 40% is contained in
extracurricular space.
Adding a hypertonic solution to the ECF
decreases cell volume, whereas adding
a hypotonic solution increases it.
Classifications/ Etiology and
Pathophysiology/ Treatments and
Diagnosis
1. Disorders of Sodium and Water
Homeostasis
Hypernatremia
- (Pathophysiology) Resulting
from an imbalance between
the amount of water and
sodium in the extracellular
space as a urinary output;
Water Loss.
2. Disorders
Clinical Presentation
- Weakness, lethargy,
restlessness, irritability, and
disorientation are all potential
results of a lack of neuronal
cell volume.
- Rapidly progressing
hypernatremia causes
twitching, seizures, coma, and
eventually death.
Treatment
- Saline treatment
- Treat central DI with
intranasal desmopressin
- By decreasing ECF volume
with a thiazide diuretic and
dietary sodium restriction
- Treat sodium overload with
loop diuretics
Hyponatremia – Caused by water
loss, hypotonic fluids, hypertonic
fluid administration, or, less
frequently, sodium ingestion.
Clinical presentation
- Asymptomatic
- Symptoms progress from
nausea and malaise to
headache and lethargy and,
eventually, to seizures, coma,
and death if hyponatremia is
severe or develops rapidly.
- It presents with decreased
skin turgor, orthostatic
hypotension, tachycardia, and
dry mucous membranes.
Treatment
- The rate of administration of
infuscate should be adjusted
to avoid exceeding a rise in
serum sodium greater than 12
mEq/L (12 mmol/L) per day
of Calcium
Homeostasis
Hypercalcemia
- (Pathophysiology) Results of
one or a combination of three
primary mechanisms
(increased bone resorption,
increased GI absorption,
increased tubular reabsorption
by the kidneys)
Clinical Presentation
- Mild to moderate and can be
asymptomatic
Treatment
- Correction of fluid and
electrolyte abnormalities
 ELECTROLYTE HOMEOSTASIS
- Rehydration - In severe cases, the use of IV
- Bisphosphonates administration is
- Denosumab recommended.
Hypocalcemia Hypophosphatemia
- (Pathophysiology) Results of - (Pathophysiology) Decreased
alterations in the effect of the GI absorption and chronic
parathyroid hormone and alcoholism
vitamin D on the bone, gut,
and Kidney. Clinical Presentation

Clinical Presentation - In severe cases, neurologic

manifestations occur as well
- Dependent on the onset of as skeletal muscle
hypocalcemia. dysfunction, muscle weakness
o Tetany and dysfunction.
Treatment Treatment
- Correction of electrolyte - Severe cases: IV Phosphorus
problems replacement
- Oral calcium supplementation - Asymptomatic cases: Oral
- Vitamin D if seral calcium is Phosphorus with daily intake
not normalized with the goal of correcting
3. Disorders of Phosphorus serum phosphorus
Homeostasis concentration in 7-10 days.
4. Disorders of Potassium
Hyperphosphatemia Homeostasis
- (Pathophysiology) Hypokalemia
Phosphorus excretion - (Pathophysiology) Caused by
decrease is the most typical a lack of serum potassium or
cause. Phosphate release an internal redistribution of
from within cells is another serum potassium.
possibility. Clinical Presentation
Clinical Presentation - Depending on how severe the
Acute symptoms such as: hypokalemia is and how
quickly it develops, there may
- Gastrointestinal disturbances be a wide range of nonspecific
- Lethargy and very varied symptoms.
- Obstruction of urinary tract Symptoms of mild
- Seizures hypokalemia are uncommon.
Treatment - Cardiovascular manifestations
cardiac arrhythmias
- Decrease phosphate - Moderate hypokalemia is
absorption associated with muscle
weakness, cramping, malaise,
and myalgias
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Treatment - sedation, hypotonia,
hyporeflexia, somnolence,
- Chronic loop or thiazide coma, muscular paralysis,
diuretics and, ultimately, respiratory
- Administration of potassium depression.
Hyperkalemia - hypotension, cutaneous
vasodilation, QT-interval
- (Pathophysiology) develops prolongation, bradycardia,
when potassium intake primary heart block, nodal
exceeds excretion or when rhythms, bundle branch block,
the transcellular distribution of QRS- and then PR-interval
potassium is disturbed. prolongation, complete heart
Clinical Presentation block, and asystole.

- Hyperkalemia is frequently Treatment

asymptomatic; patients might - IV calcium
complain of heart palpitations - Forced diuresis can promote
or skipped heartbeats magnesium elimination in
Treatment patients with normal renal
function
- Treatment depends on the
desired rapidity and degree of Hypomagnesemia
lowering
- Dialysis is the most rapid way - (Pathophysiology) This is
to lower serum potassium usually associated with
concentration. disorders of the intestinal tract
- Sodium polystyrene sulfonate or kidney. It is also commonly
5. Disorders of Magnesium associated with alcoholism.
Homeostasis
Hypermagnesemia Clinical Presentation
- (Pathophysiology) Magnesium - Typically asymptomatic
concentrations steadily - The cardiovascular and
increase as the GFR neuromuscular systems play
decreases. Other causes the most significant roles.
include magnesium-containing Heart palpitations, tetany,
antacids in patients with renal jerking, and widespread
insufficiency, enteral or convulsions are all symptoms.
parenteral nutrition in patients
with multiorgan system failure, Treatment
magnesium for treatment of - IV bolus injection is
eclampsia, lithium therapy, associated
hypothyroidism, and Addison - Administer IV magnesium if
disease. serum concentrations are
Clinical Presentation less’
- Oral magnesium
- Symptoms are rare supplementation
 ELECTROLYTE HOMEOSTASIS
Monitoring
The primary end point for monitoring
treatment of fluid and electrolyte
disorders is the correction of the
abnormal serum electrolyte. Monitoring
is initially performed at frequent
intervals.
Monitor all electrolytes as individual
electrolyte abnormalities typically coexist
with another abnormality
Monitor patients for resolution of clinical
manifestations of electrolyte
disturbances and for treatment-related
complications.