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ELECTROLYTE IMBALANCES
Signs and symptoms of a fluid and electrolyte imbalance are often subtle blood chemistry tests
help diagnose and evaluate electrolyte imbalance.

ELECTROLYTE
DIAGNOSTIC
SIGNS AND SYMPTOMS
TEST RESULTS
IMBALANCES
*Muscle twitching and
weakness due to osmotic
swelling of cells
*Lethargy, confusion, *Serum sodium <135 mEa/l
seizures,and coma due to *Decreased urine specific gravity
altered neurotransmission *Decreased serum osmalality
*Hypertension and tachycardia *Urine sodium > 100 mEq/24 hours
HYPONATREMIA due to decreased extracellular *Increased red blood cell count
circulating volume
*Nausea,vomiting, and
abdominal cramps due to edema
affecting receptors in the brain
or vomiting center of the brain stem
*Oliguria or anuria due to renal
dysfunction
*Agitation, restlessness, fever,
and decreased level of
consciousness due to altered *Serum sodium > 145 mEq/l
cellular metabolism *Urine sodium <40 mEq/24 hours
*Hypertension, tachycardia, *High serum osmolality
pitting edema, and excessive
weight gain due to water shift
HYPERNATREMIA from intracellular to
extracellular fluid
*Thirst, increased viscosity of
saliva, rough tongue due to fluid
shift
*Dyspnea, respiratory arrest,
and death from dramatic
increase in in osmotic pressure
*Dizziness, hypotension, *Serum potassium < 3.5 mEq/l
arrhythmias, electrocardiogram *coexisting low serum calcium
HYPOKALEMIA (ECG) changes, and cardiac and magnesium levels not
arrest due to changes in responsive to treatment for
membrane excitability hypokalemia usually suggest hypomagnesemia
 *Nausea, vomiting, anorexia,
diarrhea, decreased peristalsis, *metabolic alkalosis
and abdominal distention due to *ECG changes include flattened
decreased bowel motility Waves, elevated U waves,
*Muscle weakness, fatigue, and Depressed ST segment
leg cramps due to decreased
neuromuscular excitability
*Tachycardia changing to
bradycardia,ECG changes, and *Serum potassium > 5mEq./l
cardiac arrest due to *Metabolic acidosis
hypopolarization and alterations *ECG changes include tented
in repolarization and elevated T waves, widened
*Nausea, diarrhea, and QRS complex,
HYPERKALEMIA
abdominal cramps due to prolonged PR interval, flattened
decreased gastric motility or absent P waves, depressed
*Muscle weakness and flaccid ST segment
paralysis due to inactivation of
membrane sodium channels

*Muscle hypertonicity and

tetany *Serum chloride <98 mEq/l
*Shallow, depressed breathing *Serum pH > 7.45 (supportive value)
*Usually associated with *Serum CO2 >32 mEq/l
HYPOCHLOREMIA
hyponatremia and its (supportive value)
characteristic symptoms, such
as muscle weakness and
twitching
*Deep, rapid breathing
*Serum chloride > 108 mEq/l
*Weakness
HYPERCHLOREMIA *Serum pH < 7.35, serum CO2
*Diminished cognitive ability,
<22 mEq/l (Supportive values)
possibly leading to coma
*Anxiety, irritability, twitching *Serum calcium <8.5 mg/dl
around the *Low platelet count
mouth,laryngospasm,seizures, *ECG shows lengthened QT
Chvostek's and Trousseau's interval, prolonged ST segment,
HYPOCALCEMIA
signs due to enhanced arrhythmias
neuromuscular irritability *Possible changes in serum
*Hypotension and arrhthmeas protein because half of serum
due to decreased calcium influx calcium is bound to albumin
*Drowsiness, lethargy, *Serum calcium > 10.5 mg/dl
HYPERCALCEMIA headaches, irritability, *ECG shows signs of heart
confusion, depression, or apathy block and shortened QT interval
 due to decreased neuromuscular
irritability ( increased threshold)
*Weakness and muscle
*Azotemia
flaccidity due to depressed
*Decreased parathyroid
neuromuscular irritability and
hormone level
release of acetylcholine of the
*Sulkowitch urine test shows
myonearal junction
increased calcium precipitation
*Bone pain and pathological
fractures due to calcium loss
from bones
*Heart block due to decreased
neuromuscular irritability
*Anorexia, nausea, Vomiting,
constipation, and dehydration
due to kidney stone formation
*Nearly always coexists with
hypokalemia and hypocalcemia *Serum magnesium < 1.5 mEq/l
*Hyperirritability, tetany, leg *Coexisting low serum
and foot cramps, positive potassium and calcium levels
Chvostek's and Trousseau's signs
HYPOMAGNESEMIA confusion in neuromuscular transmission
*Arrhythmias, vasodilation, and
hypotension due to enhanced
inward sodium current or
concurrent effects of calcium
and potassium imbalance
*Hypermagnesemia is
uncommon, caused by
*Serum magnesium > 2.5 mEq/l
decreased renal excretion (renal
*Coexisting elevated potassium
failure) or increased intake of magnesium
and calcium levels
*Diminished reflexes, muscle
weakness to flaccid paralysis
due to suppression of acetylcholine
release of the myoneural
HYPERMAGNESEMIA junction, blocking cell excitability
*respiratory distress secondary
to respiratory muscle paralysis
*Heart block, bradycordia due
to decreased
inward sodium current
*Hypotension due to relaxation
of vascular smooth muscle and
reduction of vascular wall surface
 *Muscle weakness, tremor, and
*Serum phosphates < 2.5mg/dl
paresthesia due to deficiency of
*Urine phosphate > 1.3 g/24 hours
HYPOPHOSPHATEMIA adenosine triphasphate
*Peripheral hypoxia due to 2,3 -
diphosphoglycerate deficiency
*Serum phosphates > 4.5 mg/dl
*Usually asymptomatic unless
*Serum calcium < 9mg/dl
HYPERPHOSPHATEMIA leading to hypocalcemia, with
*Urine phosphorus < 0.9 g/24
tetany and seizures
hours