What Are Electrolyte Imbalances?

Electrolyte imbalances such as increased or decreased concentrations of sodium, potassium, and calcium in your blood can cause many different medical problems. If severe, these imbalances can lead to some significant and even life-threatening problems. Electrolyte abnormalities also are used to help diagnose a wide variety of medical problems.

Electrolytes are particles that carry either a positive or negative charge. These minerals are dissolved in your body’s fluids. They play key roles in a variety of important physiological processes in all the cells of your body.

For example, electrolytes are necessary for the proper contraction of your muscles, including the muscles of your heart. If your electrolyte levels are off, it can affect the way your nerves signal in the body. They are critical for making sure your blood doesn’t become too acidic or too alkaline. Some electrolytes, like calcium, are key for blood clotting and bone health. Electrolytes are also important for making sure that enough water stays inside cells and that not too much water leaves the body.

Electrolytes are found naturally in many foods and drinks. Specific electrolytes are also added to certain sports drinks advertised to replenish them when this might be needed (like after intense exercise). Most people get enough electrolytes from the foods that they eat, but specific circumstances might cause those electrolytes to get out of whack.

Your body works hard to keep the body’s electrolytes within a certain concentration in your blood. For example, if a certain electrolyte is too high, the kidney might try to release more of it in your urine. Problems can happen if electrolytes are too high or too low. That's called an electrolyte imbalance, when the concentration of the specific electrolyte falls outside the normal range. Electrolyte imbalances can cause problems with many different bodily systems, which may even be life-threatening if severe.

One of the most common electrolyte imbalances is hyponatremia, low levels of sodium in the blood. Other particularly important types are elevated sodium (hypernatremia), abnormalities in potassium (hypokalemia or hyperkalemia), abnormalities in calcium (hypercalcemia or hypocalcemia), and imbalances in magnesium (hypermagnesemia or hypomagnesemia).

Electrolyte imbalances can cause problems themselves, but they are also often indicators of other problems in the body. For that reason, they play an important role in the diagnosis of many different medical conditions. Sometimes, a person might have more than one type of electrolyte that is outside the normal range.

Electrolyte imbalances are particularly common in elderly people and in people who are critically ill.

Symptoms vary based on the specific electrolytes involved, as well as the severity of the imbalance.

Depending on the situation, some potential symptoms might include:

• Headache
• Dizziness
• Confusion
• Fatigue
• Nausea and vomiting
• Frequent urination
• Constipation
• Increased heart rate
• Muscle cramps or muscle weakness
• Poor coordination when walking
• Bone pain

If severe, some electrolyte imbalances can cause very serious problems, such as heart rhythm abnormalities, seizures, coma, and death.

However, electrolyte imbalances might not cause any noticeable symptoms at all. This is especially likely to be the case if the imbalance is mild or if the imbalance has been coming on gradually.

Electrolyte imbalances also increase the risk of complications and death in people who already have serious medical conditions.

A variety of different causes can lead to electrolyte imbalances. Any time you lose a lot of fluids from your body, you are at risk of certain electrolyte imbalances. For example, prolonged exercise with lots of sweating might cause an imbalance. Vomiting, diarrhea, and severe burns are all causes of fluid loss that might lead to electrolyte imbalances.

Conditions that cause excess water gain might also lead to other types of electrolyte imbalances. For example, someone with congestive heart failure might be at greater risk. As another example, sometimes people can also get an electrolyte imbalance if they drink very large amounts of water.

Other potential causes include:

• Kidney problems
• Diabetes
• Problems of the gastrointestinal tract
• Liver problems
• Lung problems
• Cancer
• Sepsis
• Recent trauma or surgery
• Inappropriately given intravenous fluids
• Side effects of medications (like diuretics)
• Alcohol and illicit drug use

Problems with certain hormones, like antidiuretic hormone (ADH), parathyroid hormone (PTH), or aldosterone can also cause electrolyte imbalances. This might be from a problem in the gland that makes the hormone or in part of the brain that regulates the hormone. In some cases, poor dietary intake of an electrolyte might predispose a person to an electrolyte imbalance. Sometimes, no specific cause can be identified for an electrolyte imbalance.

Diagnosis of an electrolyte imbalance can be performed with a simple blood test. Electrolytes are usually tested as a group, along with other electrolytes and additional key laboratory values.

For example, you might have many of your electrolytes tested during a set of blood tests called a basic metabolic panel or as a part of a more complete set of tests called a comprehensive metabolic panel. These tests can tell you whether you have an electrolyte imbalance in a specific electrolyte, like sodium.

However, these blood tests don’t tell why a person has an electrolyte imbalance. Sometimes that might be relatively obvious. Other times, it might require further investigation to uncover. This might mean additional blood tests or medical imaging or other diagnostic steps.

Electrolytes are often tested when a person is having symptoms but hasn’t yet been diagnosed. For example, weakness is a potential symptom of certain electrolyte imbalances. An electrolyte test may be ordered by a clinician to check for an imbalance.

Sometimes they are tested as part of monitoring for people who have certain medical conditions that might alter electrolytes. These might include illness affecting your gastrointestinal system, your kidneys, your heart, your endocrine system, or your lungs. They might need to be regularly tested if you are taking a medication that might change your electrolyte levels, like a diuretic.

When assessing the underlying causes of electrolyte imbalances, it's helpful to look at the electrolytes grouped together. That’s why these are usually done as part of a group. When paired together, certain electrolyte imbalances may signal problems in certain parts of the body. Additionally, problems in certain electrolytes may cause problems with other electrolytes. For example, a low magnesium level might be the underlying cause of a low calcium level.

If a person has a serious electrolyte imbalance, they may need other kinds of monitoring. For example, it may be important to check an electrocardiogram (ECG) to check for any heart rhythm problems.

Treatment of electrolyte imbalances will depend on the underlying medical problem. Often the electrolyte problem will resolve after the underlying health condition is treated. Especially in someone with a relatively mild imbalance, this might be the only intervention needed.

For example, someone might have an electrolyte imbalance because of untreated type 1 diabetes. In this case, getting treatment with insulin and other therapies may help correct the imbalance. If you have a problem with hypercalcemia due to a problem with your parathyroid gland, you might need surgery.

It’s also important to pinpoint any medications that might be contributing to the problem. You may need to switch to a different medication type.

If dehydration is part of the cause, a person may need to receive intravenous fluids. On the other hand, if the person is over-hydrated, they might need to limit how much fluids they are drinking and potentially take diuretics (to help them get rid of extra fluid via the urine).

Some people might also need to receive additional electrolytes for a limited period. This might be given orally or through an intravenous line. In certain circumstances, a person might be encouraged to take in extra electrolytes by focusing on certain foods in their diet.

After treatment, you will need to see if the problem corrects itself. This will require follow-up tests of electrolytes. Because electrolyte imbalances are so common in people staying in the intensive care unit, these people often have many of their electrolytes checked daily.

In someone losing a lot of fluids, it may be helpful to provide drinks that have extra electrolytes in them. For example, a child that is losing a lot of fluids through vomiting or diarrhea might benefit from an electrolyte drink to help prevent them from becoming dehydrated. Your pediatrician’s office may be able to provide guidance about when this might be helpful.

Many people are also familiar with electrolyte drinks advertised for endurance activities. Though these products can replace some of the electrolytes and fluids lost during sweating, many of them are also quite high in sugar. These may be helpful for some athletes during prolonged activities. However, water is often the only thing that is needed. Being hydrated before you begin your workout is a good way to help prevent problems. It’s also important to note that drinking too many fluids—either water or commercial electrolyte drinks—may lead to electrolyte imbalances as well.

Taking your medications exactly as prescribed may also help you reduce your risk of an electrolyte imbalance as well. In general, taking steps to control your underlying health condition (if present) may decrease your risk of a future electrolyte imbalance.

Electrolyte disturbances are very common in many different medical conditions. Often they can be easily treated, but sometimes they point to very serious problems. Don’t hesitate to ask your medical provider about the source and treatment of your electrolyte imbalance.