Electrolyte imbalances

Question 1

What causes hyponatraemia ?

Answer 1

• Most common electrolyte imbalance
• Decrease in circulating blood volume e.g congestive heart failure hepatic cirrhosis.
• disorders leading to high antidiuretic hormone (ADH) levels, like (SIADH), adrenal insufficiency, and hypothyroidism.
  -Primary polydipsia (i.e., excessive water intake), low dietary sodium intake causing an increase in blood volume, hyperglycemia, and dyslipidemia

Question 2

What causes hypernatraemia?

Answer 2

Hypernatremia, on the other hand, is usually caused by unreplaced fluid loss through the skin and gastrointestinal (GI) tract (e.g., excessive sweating, vomiting, or diarrhea), overload of hypertonic saline, medications (e.g. lithium), and rarely, following excessive physical activity that causes water to shift into cells.

Question 3

What causes hypokalaemia?

Answer 3

Hypokalemia is usually caused by low dietary intake or unreplaced fluid loss from the GI tract and urine and can be seen after excessive vomiting and loop diuretic use, respectively.

Question 4

What causes hyperkalaemia?

Answer 4

Hyperkalemia can be noted in metabolic acidosis states - this is due to extensive potassium release from cells - but can also be noted in insulin deficiency, diabetic ketoacidosis, beta-blocker use, or following cell death in chemotherapy, where intracellular stores are released. Decreased potassium excretion from the kidneys (e.g. in acute or chronic kidney disease), aldosterone deficiency, or aldosterone resistance can also cause increased potassium levels.

Question 5

What are the causes hypocholaraemia?

Answer 5

after great GI fluid losses, as well as in renal fluid losses with diuretics

Question 6

What are the causes of hypercholaraemia ?

Answer 6

can occur when fluid losses exceed chloride losses; when the body’s ability to manage excessive chloride is disrupted; or when the bicarbonate serum levels are low and chloride levels are high.

Question 7

Causes of bicarbonate imbalance ?

Answer 7

Bicarbonate levels shift in acid-base disturbances. There is an increase in bicarbonate levels in primary metabolic alkalosis and it acts as compensation in primary respiratory acidosis. Bicarbonate falls in both primary metabolic acidosis and also decreases in response to primary respiratory alkalosis.

Question 8

Causes of hypocalcaemia?

Answer 8

hypoparathyroidism, typically seen post-surgery after thyroidectomy (i.e., after thyroid removal) due to frequent accidental damage due to their proximity to the thyroid. Hypocalcemia can also be noted in severe vitamin D deficiency, due to malnutrition or malabsorption.

Question 9

Causes of hypercalcaemia?

Answer 9

Hypercalcemia can be seen in individuals with malignancies, hyperparathyroidism, or in those prescribed thiazide diuretics or lithium.

Question 10

What are the causes of hypomagnesemia?

Answer 10

after renal or GI fluid losses, and more rarely in individuals who consume excessive amounts of alcohol.

Question 11

What are the causes of hypermagnesemia?

Answer 11

Hypermagnesemia can occur after increased magnesium intake, either orally (e.g., after use of magnesium-containing medications such as antacids and laxatives) or more commonly through intravenous access.

Question 12

Causes of low phosphate levels

Answer 12

Low levels of phosphate in the blood can be seen in individuals with vitamin D deficiency, hyperparathyroidism, and refeeding syndrome, which is a potentially fatal condition that causes unexpected shifts of fluids and electrolytes in malnourished individuals following re-introduction of food.

Question 13

Causes of hyperphosphatemia

Answer 13

can be caused by hypoparathyroidism and chronic kidney disease.

Question 14

Symptoms of hyponatraemia?

Answer 14

neurological manifestations, presenting with headaches, confusion, nausea, or delirium (i.e., mental disturbance characterized by confusion and disrupted attention, disordered speech, and hallucinations). Especially if hyponatremia presents acutely, from a rapid overcorrection of hypernatremia, osmotic demyelination syndrome can occur causing cerebral edema

Question 15

Symptoms of hypernatraemia ?

Answer 15

may be agitated and unable to sleep or rest. Hypernatremia might affect their heart and respiratory rate, due to the reduction of the extracellular fluid volume, causing tachycardia or tachypnea.

Question 16

Symptoms of potassium imbalance ?

Answer 16

hypokalemia and hyperkalemia, have muscle-related symptoms, such as muscle weakness and cramping; these can also affect the cardiac muscle and cause arrhythmias. Hypokalemia can also cause constipation, whereas hyperkalemia can lead to abdominal pain or diarrhea.

Question 17

Symptoms of calcium disturbance

Answer 17

Disturbances of calcium levels present with vague symptoms of weakness, nausea, cramping. Hypocalcemia can present with the Trousseau sign; this is characterized by involuntary contraction of the muscles in the hand and wrist after the compression of the upper arm with a blood pressure cuff; and the Chvostek sign, which is characterized by spasm of the facial muscles when gently tapping an individual’s cheek, in front of the ear.

Question 18

Symptoms of magnesium imbalance

Answer 18

Magnesium depletion may also return positive Trousseau’s and Chvostek’s signs and should be suspected in lethargic individuals presenting with tremor or personality changes. Hypomagnesemia is frequently associated with hypokalemia, therefore while trying to correct the electrolyte imbalances management of the hypomagnesemia may proceed hypokalemia treatment. Hypermagnesaemia is mostly associated with decreased consciousness, confusion, muscular weakness, and the absence of reflexes.

Question 19

Symptoms of phosphate imbalance ?

Answer 19

Any imbalance of phosphate levels usually causes muscle cramping, weakening, and numbness, and can also affect bone density, resulting in softened or weakened bones. Bicarbonate disturbances often present with headaches, fatigue, and any other symptoms related to the underlying acid-base disturbance.

Question 20

How are electrolyte balances diagnosed?

Answer 20

In order to diagnose any electrolyte imbalance, a thorough review of medical and personal history is often necessary. Additional information obtained by relatives can also be helpful if the individual is not mentally capable of answering questions (e.g., with hyponatremia). Notably, review of medications prescribed (e.g., diuretics like furosemide, or antibiotics like amphotericin B) is key to diagnosis, as they are frequently the cause of electrolyte imbalances. Measurement of electrolyte levels in the blood, available through a comprehensive metabolic panel blood test, is also necessary for diagnosis confirmation. An arterial blood gas (ABG) test may also be ordered to determine the acid-base status. Mixed electrolyte, acid-base, and fluid disturbances occur frequently and can be challenging to diagnose due to their complex clinical presentation.

Question 21

How is an electrolyte imbalance treated?

Answer 21

Each electrolyte imbalance requires a different approach in order to be treated. Treatment of the underlying cause is the most effective way to restore the electrolytes to their expected values. Intravenous fluid administration and replacement of any needed electrolyte may be helpful. Minor electrolyte disturbances can be corrected with small dietary changes, like eating more fruits and vegetables or drinking a sports drink to increase hydration and restore electrolyte balance. The rate at which the imbalance is corrected should always be monitored, as there may be significant consequences for the individual. For example, rapid correction of hypernatremia can cause cerebral edema.