Electrolyte Imbalance: Types, Diagnosis, and Treatment

An electrolyte imbalance is the excess or lack of certain minerals in the body, such as sodium or calcium. Your body gets the electrolytes it needs from the intake of foods, liquids, and supplements. However, consuming too much, or not enough water can lead to an electrolyte imbalance.

An electrolyte imbalance can also be caused by fluid loss due to excessive diarrhea or vomiting. Certain medical conditions and treatments can also cause an electrolyte imbalance.

Electrolyte imbalances can range from mild to severe. More severe cases can cause damage to the nervous system, heart, and kidneys.

Doctors diagnose an electrolyte imbalance using blood and urine tests. Treatment for a mild imbalance can include consuming certain foods or liquids. However, hospital care is sometimes necessary for severe cases to help prevent complications.

Keep reading to learn about electrolytes and the types of electrolyte imbalances, their causes, and treatments.

Electrolytes are salts or minerals that release charged particles called ions. They allow electrical signals to be carried throughout your body.

Electrolytes support many essential bodily functions, including:

• balancing fluid levels
• maintaining proper pH (acidity) balance
• moving nutrients and waste in and out of cells
• carrying electrical signals through your nervous system

Electrolytes are found in your blood, urine, and other bodily fluids. Some important electrolytes include:

• sodium
• potassium
• bicarbonate
• chloride
• calcium
• magnesium
• phosphate

The balance of electrolytes in your body can change in response to a variety of conditions. For example, sweating from exercise, hot weather, or illness may lower your levels of certain electrolytes. When this happens, it is important to replenish lost electrolytes to prevent dehydration, a potentially life threatening condition.

After replacing lost fluids, the water you take in travels to areas in your body where electrolyte concentrations are highest. Your kidneys then balance the concentration of electrolytes by either retaining them or excreting them in your urine.

An electrolyte imbalance can involve one or several different minerals.

Sodium ions have a positive charge. They help balance the amount of water in your body and allow your cells to take up nutrients. Changes in sodium ion concentration can affect many areas of your body, including the brain. Types of sodium imbalances include:

• hyponatremia, or low sodium, which may cause neurological symptoms such as confusion and headaches
• hypernatremia, or high sodium, which may cause fast breathing, restlessness, and trouble sleeping

Potassium ions have a positive charge. Potassium is critical for maintaining a regular heart rhythm. Changes in potassium levels can cause heart-related symptoms such as:

• hypokalemia, or low potassium, which may cause weakness, fatigue, and muscle twitches
• hyperkalemia, or high potassium, which may cause arrhythmia or irregular heart rhythm, as well as muscle cramps and weakness

Bicarbonate has a negative charge and is made of a combination of hydrogen ions and carbon dioxide. It is the most abundant form of carbon dioxide in the blood. Bicarbonate levels are a good measure of pH balance in the body.

Low bicarbonate levels in the blood may suggest your body is too acidic, or your pH is too low. The medical term for this is metabolic acidosis. Symptoms are non-specific, but can include:

• headache
• fast heartbeat
• fatigue
• loss of appetite
• nausea with or without vomiting

Chloride plays a key role in balancing fluid levels and pH. Because chloride ions have a negative charge, too many can lower pH in the body. The lower the pH, the higher the acidity. Types of chloride imbalances include:

• hypochloremia, or low chloride, which may cause arrhythmia
• hyperchloremia, or high chloride, which may cause muscle spasms, arrhythmia, and vague neurological symptoms

Calcium is found in your bones and teeth. As an electrolyte, it is positively charged and necessary for nerve impulses and muscle contractions. Types of calcium imbalances include:

• hypocalcemia, or low calcium, which may cause muscle spasms, twitches, aches, confusion, and tingling in the lips, fingers, and feet
• hypercalcemia, or high calcium, which may cause muscle weakness, confusion, constipation, and large volumes of urine

Your bones contain a high amount of magnesium. As a positively charged mineral, magnesium is critical for the functioning of many different enzymes. Types of magnesium imbalances include:

• hypomagnesemia, or low magnesium, which may cause ventricular arrhythmias
• hypermagnesemia, or high magnesium, which may diminish reflexes and lower blood pressure and respiration

Phosphate is negatively charged and plays a role in metabolizing nutrients. It is also a major component of bone, DNA, and cell membranes. Types of phosphate imbalances include:

• hypophosphatemia, or low phosphate, which may not cause symptoms but can eventually lead to muscle weakness, bone loss, and anorexia
• hyperphosphatemia, or high phosphate, which may only cause symptoms when occurring with hypocalcemia and may cause muscle spasms or twitches

Symptoms of an electrolyte imbalance depend on the electrolyte, the severity of the imbalance, and other factors. A mild imbalance may not cause any symptoms.

Here is a summary of possible symptoms of an electrolyte imbalance:

• general symptoms:
  • fatigue
  • stiff or aching joints
  • nausea with or without vomiting
  • constipation
• neurological symptoms:
  • dizziness
  • trembling or tremor
  • muscle weakness
  • muscle spasms or twitches
• kidney and urinary symptoms:
  • dark urine
  • decreased or increased urine output
• skin and mucous membrane-related symptoms:
  • dry mouth and foul breath
  • dry skin
  • lack of perspiration

Electrolyte imbalances can sometimes lead to severe and life threatening dehydration. Seek immediate medical care by calling 911 for symptoms including:

• change in alertness
• behavioral changes such as:
  • confusion
  • delirium
  • lethargy
  • hallucinations
  • delusions
• poor skin elasticity
• rapid heart rate
• sunken eyes
• no urine output

Medical conditions, certain treatments, and loss of fluids such as from sweating can lead to an electrolyte imbalance.

Medical conditions that may lead to an electrolyte imbalance include:

• Addison’s disease
• alcohol use disorder
• diabetes
• diarrhea or vomiting
• heat exhaustion
• kidney disease
• infection such as pneumonia or urinary tract infection
• cancer
• sepsis

Electrolyte imbalances may be caused by certain medications and supplements, including:

• angiotensin-converting enzyme (ACE) inhibitors
• hormones that are potassium-sparing, which can cause the kidneys to retain potassium
• diuretics, which promote fluid excretion by the kidneys
• cancer therapies
• calcium supplements
• potassium supplements

Electrolyte imbalances in children may be due to common illnesses such as those that cause diarrhea and vomiting. These can cause too much fluid loss, leading to water and electrolyte imbalances.

Children with critical illnesses such as from a respiratory or neurological condition may also experience an electrolyte imbalance. A small study of critically ill pediatric patients showed that 84% had an electrolyte imbalance. Hypocalcemia was the most common imbalance found.

Your doctor may check your electrolyte levels during routine blood tests or if you experience symptoms that may indicate an imbalance. They may also regularly monitor your electrolyte levels if you are experiencing illness or taking certain medications.

Blood tests used to diagnose an electrolyte imbalance include:

• Basic metabolic panel (BMP): This measures electrolytes, glucose, and certain waste products in the blood.
• Anion gap: This compares levels of different electrolytes to investigate possible pH imbalance.
• Comprehensive metabolic panel (CMP): This includes a BMP and also measures liver and kidney function.

Learn more about a Basic Metabolic Panel (BMP) Test and a Comprehensive Metabolic Panel (CMP) Test.

Your particular symptoms and the results of any tests will determine the next steps. For example, your doctor may order an EKG to evaluate heart-related symptoms.

Your doctor may also perform a physical exam and ask about your symptoms. This can help them identify any underlying cause.

Questions a doctor may ask about your symptoms include:

• When did you start experiencing symptoms?
• Are you taking any medications?
• Do you have any diagnosed medical conditions?
• Have you been exercising or working outdoors in hot weather?
• How many glasses of water or other fluids have you been drinking?
• Do you drink alcohol?

Treatments for electrolyte imbalances can vary widely depending on the type, severity, and cause. They can include:

• taking in more or less fluids by mouth
• using an oral rehydration solution
• taking salts or minerals as pills
• receiving IV fluids, or fluids administered through a vein, such as a saline solution with additional minerals
• taking medications to manage an underlying cause such as kidney disease

A severe electrolyte imbalance can lead to:

• cerebral edema (swelling of the brain)
• seizures
• shock
• coma

It is also possible to develop complications from overcorrecting for an electrolyte imbalance. Always contact a doctor for a diagnosis and guidance before attempting self-treatment.

You can prevent an electrolyte imbalance not caused by an underlying condition by drinking plenty of water and eating a healthy diet. If you sweat a lot or are in a hot or humid environment, drink more fluids and limit your alcohol intake.

If you have a medical condition or are undergoing therapies that carry a risk for electrolyte imbalance, you may need to take extra precautions. Talk with your doctor for guidance if you have any concerns. Steps you may need to take can include:

• altering your fluid intake
• consuming certain foods rich in a specific mineral such as bananas, which are high in potassium
• taking supplements or medications

The following frequently asked questions have been reviewed by Grant Tinsley, Ph.D.

According to research, hyponatremia, or low sodium, may be the most common type of electrolyte imbalance.

An oral rehydration solution (ORS) is an effective way to replenish electrolytes and treat dehydration. In cases of cholera, ORS can even save lives. However, in a hospital or urgent care setting, you may receive fluids intravenously (IV).

An electrolyte imbalance is an elevated or reduced amount of certain salts and minerals in your body. The imbalance can be mild or severe, and in some cases may lead to life threatening brain or heart problems.

An electrolyte imbalance can have a variety of causes, from excess fluid loss to cancer. Certain medications may also cause an electrolyte imbalance.

Treatment includes adjusting water or food intake, and administering electrolyte fluids, supplements, or medications.