What Causes Electrolyte Imbalance and How to Treat It

An electrolyte imbalance is when the concentration of certain important minerals in your blood falls outside the normal range. Electrolytes are minerals like sodium, potassium, and calcium that play key roles in a variety of processes in all the cells of your body.

Electrolyte imbalances can cause problems with many different bodily systems. If severe, they may even be life-threatening.

This article looks at electrolyte imbalances, what they mean, and the symptoms they can cause. It also covers how electrolyte abnormalities can be used to help diagnose a wide variety of medical problems.

Types and Causes of Electrolyte Imbalances

Electrolyte imbalances are 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, however, no specific cause can be identified for an electrolyte imbalance.

It is possible to 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.

Sodium

One of the most common electrolyte imbalances is hyponatremia, low levels of sodium in the blood. Hyponatremia can occur when there is a decrease in the amount of blood circulating in your body. This can happen with conditions such as:

• Congestive heart failure
• Advanced liver disease
• Adrenal insufficiency

Hyponatremia can also be caused by high levels of antidiuretic hormone, a hormone that helps regulate the water in your body.

Other conditions that can cause hyponatremia include:

• Excessive water intake
• Low dietary sodium
• Hyperglycemia
• Hypothyroidism

It is also possible to have elevated sodium levels. This is called hypernatremia. Hypernatremia is often caused by excess fluid loss, which can happen when:

• You have severe vomiting or diarrhea
• You take certain medications, such as Lithobid (lithium)
• You eat large amounts of high-sodium foods

Calcium

Hypocalcemia is when you have low levels of calcium in your blood. Hypocalcemia is often associated with hypoparathyroidism, a condition that can occur after you have your thyroid gland removed. Your thyroid gland is close to your parathyroid glands, which makes them vulnerable to damage during this procedure.

Hypoparathyroidism can also be caused by certain autoimmune conditions or a genetic disease.

Hypocalcemia can also be related to other conditions such as:

• Severe vitamin D deficiency due to malnutrition or a condition that leads to poor absorption of nutrients in the digestive system
• Kidney failure
• Pancreatitis
• Prostate or breast cancer

Medications can also cause hypocalcemia:

• Certain chemotherapy drugs
• Diuretics
• Anti-convulsants
• Osteoporosis medication

High levels of calcium, called hypercalcemia, can happen with conditions such as:

• Certain cancers, including lung and breast cancer
• Hyperparathyroidism
• Kidney disease
• Lung diseases such as tuberculosis

Certain medications can also cause hypercalcemia:

• Thiazide diuretics
• Lithium
• Antacids
• Excess use of calcium or vitamin D supplements

Potassium

Low potassium is called hypokalemia. It can happen when medical conditions or medication use cause fluid loss from the gastrointestinal system or urinary tract. For example:

• Excessive vomiting
• Taking diuretics

Hyperkalemia—when you have too much potassium in your blood—is related to a number of different conditions, including:

• Metabolic acidosis, which occurs when your kidneys aren't able to remove excess acids from your blood
• Insulin deficiency
• Diabetic ketoacidosis
• Kidney disease

Hyperkalemia can also happen when you take certain medications, such as:

• Beta-blockers
• Calcium-channel blockers
• Angiotensin-II receptor blockers
• Non-steroidal anti-inflammatory medication
• Certain antimicrobials such as trimethoprim and pentamidine
  

Magnesium

Hypomagnesemia refers to reduced levels of magnesium in the blood. It usually occurs when you've lost too many fluids through vomiting or diarrhea or when you are losing too much magnesium in your urine. Some of the things that can cause hypomagnesemia include:

• Gastrointestinal conditions such as Crohn's disease or short bowel syndrome
• Type 2 diabetes
• Heavy alcohol use
• Low dietary intake of magnesium

Certain medications may also cause hypomagnesemia:

• Proton pump inhibitors
• Diuretics
• Certain antibiotics and antifungals
• Certain chemotherapy medication

Hypermagnesemia is when you have too much magnesium in your blood. Hypermagnesemia is common in people with chronic kidney disease and people who are hospitalized with kidney injury. Certain medical conditions can also cause hypermagnesemia, such as:

• Diabetic ketoacidosis
• Metabolic acidosis
• Hyperparathyroidism

People who take too much magnesium as a dietary supplement are also at risk for hypermagnesemia.

Chloride

Hypochloremia (too little chloride in the blood) can also happen when you lose too many fluids through your gastrointestinal system or your urinary tract. Some of the things that can cause this include:

• Severe vomiting or diarrhea
• Kidney problems
• Insufficient dietary chloride
• Chronic respiratory acidosis

Certain medications like diuretics can also cause hypochloremia.

Hyperchloremia (too much chloride) can happen when you lose more fluid than chloride. It can be related to:

• Loss of fluids from diarrhea
• Dehydration through excessive sweating, high fever, or other causes
• High levels of sodium in the blood
• High salt intake
• Certain conditions such as diabetes insipidus and chronic kidney disease

Phosphate

Hypophosphatemia (low phosphate) can have a number of causes, including:

• Vitamin D deficiency
• Hyperparathyroidism
• Malnutrition
• Chronic diarrhea
• Refeeding syndrome, which can occur in malnourished people who have resumed eating

Hyperphosphatemia (high phosphate) can be caused by:

• Hypoparathyroidism
• Chronic kidney disease
  

Electrolyte Imbalance Symptoms

Symptoms vary based on the specific electrolytes involved, as well as the severity of the imbalance. Some potential symptoms could 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, electrolyte imbalances can cause very serious problems, such as:

• Heart rhythm abnormalities
• Seizures
• Coma
• 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.

Diagnosing 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 key laboratory values.

For example, you might have many of your electrolytes tested during a series 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 imbalance in a specific electrolyte.

However, these blood tests don’t tell you why you have an electrolyte imbalance. Sometimes the reasons might be obvious. In other situations, your healthcare provider may need to order additional blood tests, medical imaging, or other diagnostic tests to find the cause of your electolyte imbalance.

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.

Sometimes electrolytes are tested as part of monitoring for people who have certain medical conditions that could alter electrolytes. These might include illnesses affecting organs like:

• The kidneys
• The heart
• The endocrine system
• The gastrointestinal system
• The lungs

Your electrolytes may need to be regularly tested if you are taking a medication that can change your electrolyte levels, like a diuretic.

Electrolyte levels are usually tested together since this can help your healthcare provider find the underlying cause of an imbalance. When paired together, certain electrolyte imbalances may signal problems in parts of the body.

Additionally, problems with 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 you have a serious electrolyte imbalance, you may need other kinds of monitoring. For example, you may need an electrocardiogram (ECG) to check for heart rhythm problems.

Treatment

Electrolytes are found naturally in many foods and drinks. Sports drinks can help replenish lost electrolytes in certain situations, like after intense exercise.

Most people get enough electrolytes from the foods they eat, but sometimes other interventions are needed to correct an imbalance.

Treating Underlying Medical Problems

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

For example, you 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 an issue 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.

Fixing Dehydration or Overhydration

If dehydration is part of the cause, you may need to receive intravenous fluids. On the other hand, if you are over-hydrated, you might need to limit your fluid intake and potentially take diuretics to help get rid of extra fluid via the urine.

Adjusting Electrolytes

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

Monitoring

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

How to Prevent Electrolyte Imbalances

If you're losing a lot of fluids through vomiting or diarrhea, an electrolyte drink can help prevent dehydration. If your child is vomiting or has diarrhea, ask your pediatrician for advice on when to give electrolyte fluids.

Electrolyte sports drinks can replace some of the electrolytes and fluids lost during sweating, but they can also be high in sugar. These may be helpful for some athletes during prolonged activities. However, water is often the only thing you need to drink in order to replace lost fluids.

Hydrating 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 also lead to electrolyte imbalances.

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

Summary

Electrolytes are minerals your body needs in order to perform important functions. If the concentrations of these minerals in your blood are too high or too low, you have an electrolyte imbalance.

Electrolyte imbalances can be serious, and can even cause death. They can happen when you lose too much fluid through exercise or vomiting, or when you have certain conditions like diabetes or kidney problems. Treatment usually involves treating the underlying condition and/or receiving additional electrolytes.