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Nausea
Heart palpitations
Malaise
Brain fog
Cottonmouth
Dry mouth
Leg cramps
Confusion
Irregular heartbeat
Muscle spasms
Leg cramps at night
Loss of appetite
Not seeing your symptoms? No worries!
Water and salts (sodium, potassium, calcium, etc.) form a delicate balance in the body. In this condition, the balance is disrupted by kidney injury, hormonal disturbances, and other causes.
Your doctor may ask these questions to check for this disease:
The goal of treatment is to restore electrolytes to normal levels. Mild imbalances can be managed through dietary changes and electrolyte supplements. In severe cases, salt-containing fluids may be given by a needle in the vein.
Reviewed By:
Maxwell J. Nanes, DO (Emergency Medicine)
Dr Nanes received a doctorate from the Chicago College of Osteopathic Medicine and went on to complete a residency in emergency medicine at the Medical College of Wisconsin. There he trained at Froedtert Hospital and Children's Hospital of Wisconsin in the practice of adult and pediatric emergency medicine. He was a chief resident and received numerous awards for teaching excellence during his time there. | | After residency he took a job at a community hospital where he and his colleagues worked through the toughest days of the COVID-19 pandemic. |
Yoshinori Abe, MD (Internal Medicine)
Dr. Abe graduated from The University of Tokyo School of Medicine in 2015. He completed his residency at the Tokyo Metropolitan Health and Longevity Medical Center. He co-founded Ubie, Inc. in May 2017, where he currently serves as CEO & product owner at Ubie. Since December 2019, he has been a member of the Special Committee for Activation of Research in Emergency AI of the Japanese Association for Acute Medicine. | | Dr. Abe has been elected in the 2020 Forbes 30 Under 30 Asia Healthcare & Science category.
Content updated on Jul 3, 2024
Following the Medical Content Editorial Policy
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With a free 3-min Electrolyte Imbalance quiz, powered by Ubie's AI and doctors, find possible causes of your symptoms.
This questionnaire is customized to your situation and symptoms, including the following personal information:
Biological Sex - helps us provide relevant suggestions for male vs. female conditions.
Age - adjusts our guidance based on any age-related health factors.
History - considers past illnesses, surgeries, family history, and lifestyle choices.
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Q.
High Phosphate? Why Your Levels Are Rising & Medically Approved Next Steps
A.
High phosphate levels are most often caused by chronic kidney disease, but can also come from phosphate additives in processed foods, hormone imbalances, or rapid cell breakdown; even without symptoms, persistent elevations can weaken bones and calcify blood vessels, raising heart risk. There are several factors to consider, and key details about your labs and history can change next steps; see below to understand more. Medically approved actions include confirming the cause with repeat labs plus kidney, calcium, PTH, and vitamin D tests, cutting back on phosphate additives, taking phosphate binders if prescribed, and optimizing kidney and hormone care, with urgent evaluation for chest pain, severe cramps, confusion, seizures, or irregular heartbeat. Full guidance, practical diet tips, and when to seek emergency care are detailed below.
References:
* Lau WL, et al. Hyperphosphatemia: An Update on Its Pathophysiology and Management. Adv Chronic Kidney Dis. 2020 Jan;27(1):15-22. PMID: 32093863.
* Kovesdy CP. Hyperphosphatemia Management in Chronic Kidney Disease. Kidney Int Rep. 2021 Mar;6(3):574-582. PMID: 33738472.
* Block GA, et al. Hyperphosphatemia and Phosphate Binders in Chronic Kidney Disease. Am J Kidney Dis. 2020 Jul;76(1 Suppl 1):S73-S80. PMID: 32560377.
* Wolf M. Update on Fibroblast Growth Factor 23 in Chronic Kidney Disease. Kidney Int. 2016 Nov;90(5):935-942. PMID: 27745778.
* Rosner MH, et al. Acute Hyperphosphatemia. Clin J Am Soc Nephrol. 2017 Apr;22(4):676-681. PMID: 28400494.
Q.
Heart Racing? Why Hypokalemia Occurs & Medically Approved Next Steps
A.
Heart racing or palpitations can occur with hypokalemia when potassium falls below 3.5 mEq/L, disrupting cardiac electrical signals; common causes include fluid loss from vomiting or diarrhea, diuretics and other medicines, and kidney or hormonal disorders. Medically approved next steps are prompt blood testing and often an ECG, correcting the cause, and carefully supervised potassium replacement by mouth or IV, with urgent care for chest pain, fainting, severe weakness, or sustained irregular beats. Diet can help in mild cases but check with your clinician first if you have kidney disease or take medicines that affect potassium; there are several factors to consider, so see the complete guidance below for details that can change your safest plan.
References:
* Goyal A, et al. Hypokalemia. StatPearls [Internet]. 2023 Jan. PMID: 28722928.
* Kardalas R, et al. Hypokalemia: a comprehensive review on causes, clinical manifestations and management. Eur J Intern Med. 2018 Jun;52:17-25. PMID: 29503302.
* Rivara MB, et al. Disorders of Potassium. Front Physiol. 2021 Jun 22;12:699299. PMID: 34248740.
* Macias-Ruvalcaba NA, et al. Electrolyte Disturbances and Arrhythmias in Hospitalized Patients. Cureus. 2022 Nov 22;14(11):e31766. PMID: 36561439.
* Hwang M, et al. ECG Changes in Electrolyte Abnormalities. Indian Pacing Electrophysiol J. 2016 Jan-Feb;16(1):14-23. PMID: 26973347.
Q.
Muscle Cramps? Why Your Heart Is Racing: Potassium Chloride Next Steps
A.
Muscle cramps and a racing heartbeat are often tied to electrolyte imbalances, especially low potassium, and potassium chloride can help when a clinician confirms low levels with a blood test. There are several factors to consider, including red flag symptoms that warrant urgent care, drug and kidney issues that make unsupervised potassium dangerous, and practical steps like hydration, medication review, and choosing food sources versus supplements. See below for complete guidance on when potassium chloride is appropriate, safe dosing and monitoring, and what to do next based on your symptoms.
References:
* Simon B, Maeng M, Al-Kassab A, et al. Hypokalemia: Causes, Consequences, and Correction. *Medicina (Kaunas)*. 2021 Jul 15;57(7):728. doi: 10.3390/medicina57070728. PMID: 34361517.
* Kienbaum P, et al. Electrolyte Disturbances and Cardiac Arrhythmias. *J Clin Med*. 2021 May 29;10(11):2393. doi: 10.3390/jcm10112393. PMID: 34072895.
* Mount DB. Hypokalemia: A Clinical Approach. *Am J Med Sci*. 2011 Nov;342(5):427-32. doi: 10.1097/MAJ.0b013e31821ac45b. PMID: 21876407.
* Simon LV, Hashmi MF, Farrell MW. Hyperkalemia. *StatPearls [Internet]*. 2023 Jan. PMID: 28722920.
* Weisberg LS. Clinical Manifestations of Hyperkalemia. *Crit Care Clin*. 2016 Oct;32(4):533-43. doi: 10.1016/j.ccc.2016.06.002. PMID: 27600122.
Q.
High Anion Gap? Why Your Blood Is Imbalanced & Medically Approved Next Steps
A.
A high anion gap usually means metabolic acidosis and is most often due to diabetic ketoacidosis, lactic acidosis, kidney failure, toxins, or ketosis; risk can range from mild to life threatening depending on the cause and how quickly it develops. See below for more. Next steps include prompt follow up for confirmation labs and blood gas plus glucose, lactate, kidney tests, and toxicology, and urgent care if you have red flag symptoms, with treatment targeting the cause such as IV fluids, insulin, antibiotics, dialysis, or antidotes. There are several factors to consider, and important details on symptoms, prevention, and when to go to the ER are outlined below.
References:
* Kraut, J. A., & Madias, N. E. (2015). Metabolic acidosis: pathophysiology, diagnosis and management. *Nature Reviews Nephrology*, *11*(3), 198-211.
* Kovesdy, C. P. (2020). Evaluation of High Anion Gap Metabolic Acidosis. *Kidney International Reports*, *5*(12), 2110–2119.
* Adeva-Andany, M. M., et al. (2020). Metabolic acidosis: pathophysiology, diagnosis and treatment. *World Journal of Emergency Medicine*, *11*(4), 189–201.
* Chawla, S., et al. (2019). The Anion Gap in Metabolic Acidosis: A Review. *Journal of Clinical Medicine*, *8*(12), 2095.
* Lolekha, P. H., et al. (2019). Assessment and Management of Acid-Base Disorders. *Journal of Clinical Medicine*, *8*(11), 1970.
Q.
Feeling Weak? Why Your Electrolytes Are Imbalanced & Medical Steps
A.
Electrolyte imbalance can cause weakness, fatigue, cramps, dizziness, confusion, or palpitations, often due to dehydration, kidney or hormonal problems, medications, overhydration, or chronic illness. Do not self-treat with random electrolyte drinks or supplements; see a clinician for blood tests and seek urgent care for chest pain, fainting, seizures, severe confusion, or irregular heartbeat. There are several factors to consider, including which electrolyte is off, medication adjustments, and safe hydration or diet changes; see below for the full step-by-step guidance, red flags, and when to act.
References:
* Lemoine S, Lamoine M, Le Moine P. Electrolyte Imbalances and Their Impact on Neuromuscular Function. J Clin Med. 2023 Feb 15;12(4):1581. doi: 10.3390/jcm12041581. PMID: 36836044; PMCID: PMC9959586.
* Hoorn EJ, Zietse R. Hyponatremia: A Practical Approach to Diagnosis and Treatment. Nat Rev Nephrol. 2017 Dec;13(12):780-792. doi: 10.1038/nrneph.2017.159. Epub 2017 Oct 27. PMID: 29076694.
* Kardalas R, Paschou SA, Anastasiou E, Gartzonika C, Papagianni A, Angelousi A. Hypokalemia. Endocrine. 2018 Feb;59(1):16-24. doi: 10.1007/s12020-017-1492-3. Epub 2017 Dec 8. PMID: 29222591.
* Kovesdy CP. Hyperkalemia. Kidney Int. 2018 Aug;94(2):239-247. doi: 10.1016/j.kint.2017.11.005. Epub 2017 Dec 22. PMID: 29275924.
* Rosas-Arellano MP, Rosas-Arellano G, Rosas-Arellano J, Vargas-Ojeda R, Mejia-Baranda F. Magnesium Disorders. Curr Probl Cardiol. 2023 Mar;48(3):101570. doi: 10.1016/j.cpcard.2022.101570. Epub 2022 Dec 17. PMID: 36539209.
Q.
Magnesium Oxide for Women 65+: Benefits, Risks & Safety Tips
A.
Magnesium oxide can help women 65+ with occasional constipation and to correct low magnesium, which may support muscles, nerves, heart rhythm, and bone health, but it absorbs poorly and can cause diarrhea or, with reduced kidney function, dangerous magnesium buildup. There are several factors to consider; see below for safe dosing targets of about 320 mg per day total intake and keeping supplements under 350 mg per day unless advised by a doctor, key drug interactions and timing, who should be cautious or avoid it, red flag symptoms, and when to choose food sources or other magnesium forms instead.
References:
* Barbagallo M, Belvedere M, Di Bella G. Magnesium in the elderly: a critical review. Magnes Res. 2014 Dec;27(4):191-203. doi: 10.1684/mrh.2014.0371. PMID: 25540137.
* Schuchardt JP, Hahn A. Bioavailability of magnesium from different magnesium compounds in healthy subjects--a systematic review. Magnes Res. 2017 Dec 1;30(4):119-139. doi: 10.1684/mrh.2017.0427. PMID: 29094611.
* Chen Y, Yu R, Wang P, et al. Effect of Magnesium Supplementation on Osteoporosis in Postmenopausal Women: A Systematic Review and Meta-Analysis. J Clin Densitom. 2023 Jul-Sep;26(3):365-373. doi: 10.1016/j.jocd.2023.01.002. Epub 2023 Jan 24. PMID: 36706788.
* Sama A, Dhillon H, Huda S. Magnesium for the prevention and treatment of cardiovascular disease in older adults: a systematic review. Nutr Res Rev. 2020 Jun;33(1):153-167. doi: 10.1017/S095442241900010X. Epub 2019 Jul 25. PMID: 31340880.
* Guo W, Li Y, Pang S, et al. Gastrointestinal side effects of magnesium supplements: a systematic review. J Clin Pharm Ther. 2021 Dec;46(6):1460-1469. doi: 10.1111/jcpt.13524. Epub 2021 Sep 24. PMID: 34562206.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Bennet D, Khorsandian Y, Pelusi J, Mirabella A, Pirrotte P, Zenhausern F. Molecular and physical technologies for monitoring fluid and electrolyte imbalance: A focus on cancer population. Clin Transl Med. 2021 Jun;11(6):e461. doi: 10.1002/ctm2.461. PMID: 34185420; PMCID: PMC8214861.
https://onlinelibrary.wiley.com/doi/10.1002/ctm2.461Hayes W, Longley C, Scanlon N, Bryant W, Stojanovic J, Kessaris N, Van't Hoff W, Bockenhauer D, Marks SD. Plasma electrolyte imbalance in pediatric kidney transplant recipients. Pediatr Transplant. 2019 Jun;23(4):e13411. doi: 10.1111/petr.13411. Epub 2019 Apr 11. PMID: 30973673.
https://onlinelibrary.wiley.com/doi/10.1111/petr.13411