An imbalance of these vital minerals can signal serious disease

By John Murphy
Published June 5, 2020

Key Takeaways

Many functions in the body need a small electric charge to make them happen. But where does this power come from? Electrolytes. When dissolved in water, electrolytes conduct electricity to provide this charge. When serum electrolyte levels get too high or too low, an imbalance can occur. Such imbalances can indicate metabolic disorders that may lead to life-threatening clinical conditions. 

In short, it’s vitally important to keep the body’s electrolytes in stock and in balance. 

Where do electrolytes come from? 

Electrolytes are minerals—sodium, potassium, calcium, magnesium, phosphate, chloride, and bicarbonate—that dissolve in blood, urine, and other body fluids to create electrically charged ions. Some electrolytes produce a positive charge, some a negative charge. 

Electrolytes are often associated with sports drinks like Gatorade, but there are plenty of other—and better—sources of electrolytes. 

“Sugar, salts, and water help your body absorb fluids, but a lot of sports drinks have too much sugar and not enough electrolytes to really help your body replenish the electrolytes it needs,” said clinical dietitian Christina Fasulo, MS, RD, of Cedars-Sinai, Los Angeles, CA. “For the average American, you can get all the electrolytes you need through a nutritious diet—especially when eating healthy, whole foods.”

Fruits and vegetables are good sources of electrolytes. But, some unexpected foods—like dill pickles, milk, mushrooms, and soup—can also provide electrolyte replenishment. 

What electrolytes do

Electrolytes are necessary for a number of important functions. Electrolytes help regulate nervous system function and muscle contraction, hydrate the body, balance blood acidity and pressure, and rebuild damaged tissue.

Electrolyte levels can fluctuate in relation to water levels in the body, as well as other factors. Vomiting, diarrhea, sweating, some medicines, and liver or kidney problems can all upset the body’s homeostasis of fluids and, consequently, the body’s electrolyte balance. These electrolytes need to be replaced to maintain healthy levels.

The kidneys are the chief regulator for maintaining healthy electrolyte levels, but hormonal activities are also involved in this process. A disorder in these mechanisms may deteriorate the electrolyte balances and result in medical emergencies.

An electrolyte imbalance becomes a health concern when the concentration of a certain electrolyte becomes higher than the body can regulate. Low electrolyte levels can also adversely affect health. In a study involving adult patients with electrolyte imbalances who were entering the emergency department, the most common imbalanced electrolytes were (in order) sodium, calcium, potassium, and magnesium.

Signs and symptoms of electrolyte imbalances

Symptoms of an electrolyte imbalance vary depending on which electrolyte is out of balance and whether its level is too high or too low. Common signs and symptoms include fatigue, headache, nausea, muscle cramps, blood pressure changes, low energy, tingling/numbness, thirst, dehydration, weakness, and others. If the patient is left untreated, seizures, heart rhythm disturbances, and even cardiac arrest or coma can occur. 

Certain populations are at particular risk for electrolyte imbalances. “Studies about the clinical prevalence of electrolyte imbalances often report that these disorders are frequently seen in elderly and critically ill patients, and occur in the progression of diseases such as diabetes mellitus, acute or chronic renal failures, severe cardiovascular events like myocardial infarctions, etc,” wrote the authors of the emergency department article. 

In their study, the most frequent diagnoses in patients with electrolyte imbalance were sepsis (11%), pneumonia (9%), and acute renal failure (7%).

More commonly, electrolyte imbalances are caused by dehydration due to excessive exercise, fever, vomiting, diarrhea, and overexposure to heat. This imbalance can most often be treated simply by drinking more water or other fluids. 

Causes of electrolyte imbalances

However, more serious causes of electrolyte imbalances may not be so easily diagnosed or treated. An electrolyte panel is required to determine which electrolyte is involved and whether its concentration in the blood is too low or too high. 

Once this is determined, clinicians can use this information to help diagnose the underlying cause. Examples for specific electrolyte imbalances include: 

Sodium. Excess sodium (hypernatremia) can be due to hyperaldosteronism or Cushing’s syndrome. Insufficient sodium (hyponatremia) can be caused by renal failure, hypothyroidism, or use of thiazide diuretics.

Calcium. Hypercalcemia most frequently stems from hyperparathyroidism or malignancy. Hypocalcemia may develop from toxic shock syndrome, after thyroid surgery, or with tumor lysis syndrome.

Potassium. Hyperkalemia is most commonly seen in patients with chronic renal failure. But it can also occur due to diabetic ketoacidosis, tumor lysis syndrome from chemotherapy, or the use of certain medicines (potassium-sparing diuretics, ACE inhibitors, or NSAIDs). Hypokalemia is commonly caused by gastrointestinal loss (diarrhea, laxatives), renal loss (hyperaldosteronism, severe hyperglycemia, potassium-depleting diuretics, carbenicillin, sodium penicillin, amphotericin B), or malnutrition.

Magnesium. Hypermagnesemia is most commonly due to renal failure. Hypomagnesemia usually results from decreased absorption or increased loss of magnesium from the kidneys or intestines (eg, diarrhea).

Treatment for these conditions usually involves restoring electrolyte levels that are too low or reducing levels that are too high, along with treating the underlying condition. In severe cases of life-threatening electrolyte disorders, therapy should begin before the lab results come back. 

Bottom line

Mild cases of electrolyte imbalance can often be solved by drinking water or other replenishing fluids. In severe cases, however, quick testing and aggressive treatment of the electrolyte imbalance, as well as the underlying disease, can prevent the patient from going from bad to worse. 

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