Нарушения электролитного баланса: причины, симптомы и лечение.

Electrolyte imbalance, or water electrolyte imbalance, is an abnormality in the concentration of electrolytes in the body. Electrolytes play a vital role in maintaining homeostasis in the body. They help to regulate heart and neurological function, fluid balance, oxygen delivery, acid–base balance and much more. Electrolyte imbalances can develop by consuming too little or too much electrolyte as well as excreting too little or too much electrolyte. Examples of electrolytes include calcium, chloride, magnesium, phosphate, potassium, and sodium. Electrolyte disturbances are involved in many disease processes and are an important part of patient management in medicine. The causes, severity, treatment, and outcomes of these disturbances can differ greatly depending on the implicated electrolyte. The most serious electrolyte disturbances involve abnormalities in the levels of sodium, potassium or calcium. Other electrolyte imbalances are less common and often occur in conjunction with major electrolyte changes. The kidney is the most important organ in maintaining appropriate fluid and electrolyte balance, but other factors such as hormonal changes and physiological stress play a role.

Electrolytes are important because they are what cells (especially nerve, heart and muscle cells) use to maintain voltages across their cell membranes. Electrolytes have different functions, and an important one is to carry electrical impulses between cells. Kidneys work to keep the electrolyte concentrations in blood constant despite changes in the body. Treatment of electrolyte imbalance depends on the specific electrolyte involved and whether the levels are too high or too low. The parathyroid gland is responsible for sensing changes in calcium concentration and regulating the electrolyte with parathyroid hormone.

Hypercalcemia describes when the concentration of calcium in the blood is too high. This occurs above 10.5 mg/dL. Most of the chloride in the body is from salt (NaCl) in the diet. Chloride is part of gastric acid (HCl), which plays a role in absorption of electrolytes, activating enzymes, and killing bacteria. The levels of chloride in the blood can help determine if there are underlying metabolic disorders. Generally, chloride has an inverse relationship with bicarbonate, an electrolyte that indicates acid base status.

Treat the underlying cause, which commonly includes increasing fluid intake.

Treat the underlying cause, which commonly includes increasing fluid intake. Magnesium is important in control of metabolism and is involved in numerous enzyme reactions. A normal range is 0.70 1.10 mmol/L. This is defined by a magnesium concentration >2.5 mg/dL.

Hypermagnesemia typically occurs in individuals with abnormal kidney function. This imbalance can also occur with use of antacids or laxatives that contain magnesium. Most cases of hypermagnesemia can be prevented by avoiding magnesium containing medications.

Mild symptoms include nausea, flushing, tiredness. Neurologic symptoms are seen most commonly including decreased deep tendon reflexes. Severe symptoms include paralysis, respiratory failure, and bradycardia progressing to cardiac arrest.

If kidney function is normal, stopping the source of magnesium intake is sufficient. Diuretics can help increase magnesium excretion in the urine. Severe symptoms may be treated with dialysis to directly remove magnesium from the blood.

Hypomagnesemia, or low magnesium levels in the blood, can occur in up to 12% of hospitalized patients. Symptoms or effects of hypomagnesemia can occur after relatively small deficits.

Major causes of hypomagnesemia are from gastrointestinal losses such as vomiting and diarrhea. Another major cause is from kidney losses from diuretics, alcohol use, hypercalcemia, and genetic disorders. Low dietary intake can also contribute to magnesium deficiency.

Hypomagnesemia is typically associated with other electrolyte abnormalities, such as hypokalemia and hypocalcemia. For this reason, there may be overlap in symptoms seen in these other electrolyte deficiencies. Severe symptoms include arrhythmias, seizures, and tetany.

The first step in treatment is determining whether the deficiency is caused by a gastrointestinal or kidney problem. People with no or minimal symptoms are given oral magnesium; however, many people experience diarrhea and other gastrointestinal discomfort. Those who cannot tolerate or receive magnesium, or those with severe symptoms can receive intravenous magnesium. Hypomagnesemia may prevent the normalization of other electrolyte deficiencies. If other electrolyte deficiencies are associated, normalizing magnesium levels may be necessary to treat the other deficiencies.

In minerals, phosphorus generally occurs as phosphate. Good sources of phosphorus includes baking powder, instant pudding, cottonseed meal, hemp seeds, fortified beverages, dried whey.