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Calcium, potassium and sodium levels
Low sodium levels (hyponatremia)
Hyponatremia may result from not eating enough foods containing sodium, too much sweating and urinating, or being over-hydrated.
When large amounts of fluids which do not contain sodium are given intravenously, the patient may develop hyponatremia. Diuretics cause the kidneys to expel excess sodium and water quicker - sometimes the excretion of sodium can be faster than the excretion of water.
When sodium levels are low, our bodies can produce too much of an antidiuretic hormone which tells our kidneys to retain water - this commonly happens in patients who have pneumonia, stroke and those taking certain medications, such as anticonvulsants and some SSRI (selective serotonin reuptake inhibitor) antidepressants.
Patients with diabetes, heart failure, liver failure and kidney disorders have a higher risk of experiencing low sodium levels.
Symptoms of hyponatremia - people suffering from hyponatremia may experience, confusion, headache, irritability, loss of appetite, muscle weakness, nausea, vomiting, fatigue, decreased consciousness, hallucinations, and even coma.
The Clinical Journal of Sport Medicine says that athletes who drink excessive amounts of fluids during prolonged exercise - particularly novice marathon runners - can develop dangerously low sodium levels.
High sodium levels (hypernatremia)
This is usually caused by water loss (dehydration) or the use of diuretics. Diuretics can cause both hyponatremia and hypernatremia. The first symptom of hypernatremia is thirst. Typically, patients with hypernatremia feel weak and sluggish.
When sodium levels are too high, people can suffer from confusion, paralysis, seizures and eventually coma. The best treatment is to increase water intake - sometimes this has to be done intravenously.
Low potassium levels (hypokalemia)
Some electrolyte imbalances can cause changes in heart rhythm.
Hypokalemia is often caused by using diuretics. Diuretics tend to make the kidneys excrete more potassium and water in urine.
Diarrhea and vomiting can also cause hypokalemia. If potassium levels drop slightly, there will usually be no symptoms. Prolonged slightly low potassium levels may lead to lower insulin production, resulting in an increase in blood sugar levels.
Symptoms of hypokalemia - if potassium levels drop too low the patient will suffer from fatigue, confusion, muscle weakness and cramps. If levels fall even lower, the person can become paralyzed, and have arrhythmias (unusual heart rhythms).
Patients with heart failure who take digoxin and have moderately low potassium levels are likely to develop abnormal heart rhythms. An interesting article published by The Cochrane Library looked at the benefits of diuretics for heart failure patients, while others wonder whether the changes in electrolyte levels might not outweigh the benefits.8
Low potassium is treated with potassium supplements by mouth - this can be either in tablet or liquid forms.
Patients can also raise their potassium levels by changing their diet.
Hypokalemia caused by diuretics can sometimes be resolved by switching to a potassium-sparing diuretic.
High potassium levels (hyperkalemia)
This is much more serious than hypokalemia. Hyperkalemia is usually caused by either kidney failure or medications that lower the amount of potassium excreted by the kidneys, such as the diuretic spironolactone, and angiotensin-converting enzyme (ACE) inhibitors that are used for hypertension (high blood pressure).
Patients taking these medications combined with potassium supplements or food high in potassium tend to have rapidly increasing potassium levels because their kidneys cannot get rid of it fast enough. They should stop taking the potassium supplements and change their diets. In some cases drugs that speed up the excretion of potassium are needed. Individuals with abnormal heart rhythms may be given calcium intravenously.
Researchers at the University of Texas Southwestern Medical Center in Dallas reported that heart drugs can cause a dangerous build up of potassium.
Low calcium levels (hypocalcemia)
Individuals with hypocalcemia might experience numb hands or feet
This can happen as a result of a sudden widespread blood infection, as well as infections in other tissues. If the body produces less parathyroid hormone, calcium levels can also drop - this might occur after the removal of the parathyroid glands during neck surgery.
Other reasons for hypocalcemia include anticonvulsant medications, such as phenytoin and phenobarbital, or an underactive thyroid gland.
Symptoms of hypocalcemia - people with hypocalcemia may experience numbness in the hands and/or feet, confusion, and even seizures. Treatment includes taking oral calcium supplements, and treating the disorder that caused it.
High calcium levels (hypercalcemia)
This can happen if a bone is broken down and calcium is released into the bloodstream. When cancer spreads to the bone there may be calcium release into the bloodstream. In severe cases of Paget's disease hypercalcemia can become very debilitating.
If levels of parathyroid hormone are too high hypercalcemia is much more likely - this is usually the result of a tumor in the parathyroid gland. Some cancers can cause parathyroid hormone levels to rise above normal levels. If thyroid hormone levels are abnormally high, calcium levels can rise excessively.
Symptoms of hypercalcemia - if calcium levels increase slightly most people do not have any symptoms. If levels are higher, the patient will experience dehydration because the kidneys automatically excrete more water. When levels are very high, the patient will experience nausea, loss of appetite, vomiting and confusion. There is also a risk of coma and death.
Very high levels of calcium need to be treated immediately.
What is an electrolyte panel?
The test is used to screen for any electrolyte or acid-base imbalances (the body's balance between acidity and alkalinity) and to check the effect of treatment on a known imbalance that is disrupting the proper bodily function of an organ.
An electrolyte panel is sometimes included as part of a routine physical. It can be done as a standalone test or as part of a basic metabolic panel or comprehensive metabolic panel.
The electrolyte panel is often used with hospitalized patients or those who are brought to the emergency room because acid-base and electrolyte imbalances are frequently part of acute and chronic illnesses.
If a single electrolyte is found to be either too high or too low, the doctor will keep testing for that imbalance until levels are back to normal. If an acid-base imbalance is found, blood gas tests may be done. These measure the pH, oxygen and carbon dioxide levels in an arterial blood sample to determine how severe the imbalance is and see how the patient responds to treatment.
Electrolytes may also be tested if the patient is prescribed certain drugs, especially diuretics or ACE inhibitors.
Video - Electrolytes
The bone density and fracture risk of older individuals do not improve with increased calcium intake. This is the finding of two new studies recently published in The BMJ.
Diabetes patients are at risk for a wide variety of negative health outcomes during the progression of their disease. One such area of concern is kidney function. New research hopes to spark further investigation into ways to tackle these disorders with dietary potassium.